Luca Bertoglio - Academia.edu (original) (raw)
Papers by Luca Bertoglio
European heart journal cardiovascular Imaging, 2015
Thoracic endovascular aortic repair (TEVAR) is commonly considered as a valid alternative to surg... more Thoracic endovascular aortic repair (TEVAR) is commonly considered as a valid alternative to surgery. Endoleaks occurrence is one of the principal limitations of TEVAR. Transoesophageal echocardiography (TEE) is often adopted in adjunct to fluoroscopy and angiography (ANGIO) during stent-graft implantation. In the present study, we compare intraprocedural ANGIO, TEE, and contrast-enhanced TEE (cTEE), and we also evaluate their accuracy in early endoleaks detection and characterization. Fifty-four patients with thoracic aortic disease suitable for TEVAR were prospectively enrolled in the study. After stent placement, the result of the procedure was assessed by ANGIO, TEE, and cTEE. The use of contrast (Sonovue, Bracco) significantly improved TEE quality (P = 0.0001). cTEE was superior in entry tears, false and true lumen and aneurysm thrombosis identification, and microtears and ulcer-like projections detection before stent deployment. After stent deployment, cTEE was more accurate t...
Thoraco-Abdominal Aorta, 2011
Knowledge of the spinal cord vascular supply is important in patients undergoing procedures that ... more Knowledge of the spinal cord vascular supply is important in patients undergoing procedures that involve the thoracic and thoraco-abdominal aorta. However, the spinal cord vasculature has a complex anatomy, and teaching is often based only on anatomical sketches; historically, this has required a "leap of faith" on the part of aortic surgeons. Fortunately, this "leap of faith" is no longer necessary given recent breakthroughs in imaging technologies and post-processing software that have expanded the non-invasive diagnostic ability to determine a patient's spinal cord vascular pattern, particularly in detecting the presence and location of the artery of Adamkiewicz. Computed tomography angiography fulfils the need of vascular surgeons for preoperative assessment of spinal cord anatomy, and planning of aortic interventions and procedures.
European Journal of Vascular Surgery, 1988
Annales De Chirurgie Vasculaire, 2010
ABSTRACT Les dissections rétrogrades de type A (RTAD) ne sont pas si rares après réparation aorti... more ABSTRACT Les dissections rétrogrades de type A (RTAD) ne sont pas si rares après réparation aortique endovasculaire thoracique des dissections de type B, particulièrement en présence de désordres du tissu conjonctif. Le risque de RTAD après réparation aortique endovasculaire thoracique des anévrysmes non disséquants doit être clarifié, principalement si une atteinte proximale de la crosse impose une réparation hybride avec un clampage aortique latéral, un débranchement proximal des troncs supra-aortiques et le largage du stentgraft dans l’aorte ascendante. Nous rapportons une RTAD à moyen terme après réparation hybride d’un anévrysme non disséquant de la crosse proximale sans désordres du tissu conjonctif. La technique de remplacement de l’aorte ascendante sans ablation du stentgraft de la crosse et une revue de la littérature au sujet de cette complication mal connue sont présentées.
Journal of Vascular Surgery, 2011
Journal of Vascular Surgery, 2005
Recent studies have reported different sac behavior after endovascular repair of abdominal aortic... more Recent studies have reported different sac behavior after endovascular repair of abdominal aortic aneurysms, depending on the endografts. This study was designed to evaluate mid-term outcome and sac behavior after treatment with the Gore Excluder stent-graft. Methods: Between June 1999 and January 2005, 109 selected patients with suitable anatomy were treated electively for abdominal aortic aneurysm with the Excluder stent graft. Data were prospectively collected in a computerised database and included demographics, details of the aortoiliac anatomy, procedural and clinical success, and postoperative complications. Postoperative sac size and the presence of endoleaks were assessed with computed tomography scans obtained at 1, 6, and 12 months, and yearly thereafter. All diameter measures in patients followed for >1 year (84.4%) were analyzed. Results: Assisted primary technical success was achieved in 108 cases (99.1%). No type I endoleaks and 12 (11.1%) type II endoleaks were recorded <1 month from the procedure. Mean follow-up was 29.6 ؎ 16.1 months. We recorded one new-onset type IA endoleak, complete resolution of five type II endoleaks, and eight new-onset type II endoleaks. The overall prevalence of type II endoleaks was 14%. Shrinkage at 1, 2, 3, and 4 years was observed in 20.7%, 30.5%, 38.9%, and 36.8% of cases. The presence of type II endoleak influenced the trend of aneurysm size throughout the 4 years. Aneurysms without endoleak shrank more than aneurysms with type II endoleak (P< .0001). We observed two cases of sac enlargement due to the presence of endoleaks. No cases of endotension with sac enlargement, late open conversion, or aneurysm-related deaths were observed. Unchanged aneurysmal sacs remained stable during follow-up, with no adverse events. Conclusions: Endovascular treatment with the Excluder device in selected patients produces low rates of shrinkage, but this peculiar sac behavior does not affect mid-term clinical success.
Journal of Vascular Surgery, 2013
Journal of Vascular Surgery, 2007
Journal of Vascular Surgery, 2010
Journal of Endovascular Therapy, 2012
To report endovascular treatment of a ruptured mycotic aneurysm in a patient with previous cardia... more To report endovascular treatment of a ruptured mycotic aneurysm in a patient with previous cardiac surgery, a cardioverter-defibrillator, and an intrathoracic left ventricular assist device (LVAD). Case Report: A 75-year-old man was admitted for a syncopal episode and severe back pain. The patient had a past history of postischemic dilatative cardiomyopathy for which a cardioverter-defibrillator was implanted. An LVAD and bioprosthetic aortic valve were subsequently placed due to severe cardiogenic shock. The postoperative course was complicated by methicillin-resistant Staphylococcus aureus mediastinitis and acute renal failure requiring temporary dialysis. At the current admission 4 months later, urgent computed tomography (CT) showed a ruptured aneurysm in the middle third of the descending thoracic aorta; blood cultures were positive for Candida sp. The patient was hemodynamically stable, so he was placed in intensive care and given targeted antimicrobial therapy while an endovascular treatment was planned. At surgery, a rifampicin-soaked Relay Plus 30-mm395-cm stent-graft was deployed through a right common femoral cutdown to seal the aortic rupture. Successful aneurysm exclusion was confirmed by intraoperative transesophageal echocardiography (TEE). At the 6-month follow-up, the patient was without recurrent pathology or graft infection as demonstrated by CT. Conclusion: Thoracic endovascular aortic repair in patients with LVAD is peculiar for several aspects: accurate planning is necessary to adequately visualize the aortic lesion despite the presence of many radiopaque devices and the femoral arteries are pulseless. Moreover, extremely slow washout of contrast from the aortic rupture prevents correct assessment of final sac exclusion with angiography; intraoperative TEE monitoring proved extremely useful.
Journal of Endovascular Therapy, 2010
Journal of Endovascular Therapy, 2012
Journal of Vascular …, 2012
Background: The PETTICOAT (Provisional ExTension to Induce COmplete ATtachment) technique may be ... more Background: The PETTICOAT (Provisional ExTension to Induce COmplete ATtachment) technique may be employed during endovascular treatment of type B aortic dissection (TBD) using self-expandable bare stents distal to the covered stent graft placed over the proximal entry tear. The aim of this study is to evaluate the volume changes of the true (TL) and false lumen (FL) on computed tomography (CT) scans. Methods: Since 2005, 25 selected patients received endovascular treatment for complicated TBD with the PETTICOAT technique employing the Zenith Dissection Endovascular System (William Cook Europe, Bjaerverskov, Denmark). Indications to the use of the PETTICOAT technique were the evidence of clinical manifest dynamic malperfusion in five cases (20%) and/or radiologic evidence of TL collapse in 20 cases (80%). Five patients were treated within 2 weeks from onset, 13 patients between 2 weeks and 3 months, and seven patients over 3 months after the initial acute event. The volumetric analysis of the changes of TL and FL obtained from CT scan performed before endovascular treatment of TBD, postoperatively and yearly thereafter were analyzed using the OsiriX software v 3.9 (Pixmeo sarl, Bernex, Switzerland). Results: Initial clinical (30 days) and midterm clinical success was observed in 21 cases (84%) and in 23 cases (92%), respectively. The volumes of the aortic TL and FL were evaluated at 30 days and midterm follow-up (mean, 38 ؎ 17 months). The following TL volumes were recorded: baseline 84 ؎ 29 cm 3 , postoperative 167 ؎ 31 cm 3 (؉98%), 1 year 193 ؎ 46 cm 3 (؉131%), and 2 years 216 ؎ 54 cm 3 (؉140%). The following FL volumes were recorded: baseline 332 ؎ 86 cm 3 , postoperative 286 ؎ 85 cm 3 (؊14%), 1 year 233 ؎ 81 cm 3 (؊30%), and 2 years 248 ؎ 112 cm 3 (؊32%). Progressive remodeling of the TL was recorded over time in both thoracic and abdominal segments with shrinkage of the FL mainly in the thoracic segment. Conclusions: These data provide insight into potential therapeutic benefit of the PETTICOAT technique. A significant immediate increase in TL could be achieved with resolution of all cases of dynamic malperfusion and TL collapse. A different behavior of volumes in the thoracic and abdominal segments was observed.
Texas Heart Institute …, 2011
The European Perspective I n Europe, several indications for thoracic endovascular aortic repair ... more The European Perspective I n Europe, several indications for thoracic endovascular aortic repair (TEVAR), although still considered "off-label," have modified the way that most surgeons approach thoracic aortic disease. Among these is the so-called hybrid repair. Patients From 1999 through 2011, 387 patients underwent TEVAR in our center. Within this cohort, 141 patients with aortic arch disease (group 1) and 47 patients with thoracoabdominal aortic aneurysms (TAAA) (group 2) were considered unfit for conventional open surgery because of severe comorbidities or previous aortic interventions. As a consequence, they were selected for hybrid repair. Results Group 1. According to Ishimaru's classification scheme, we categorized 119 atherosclerotic and 22 dissecting aneurysms as zone 0 (31) (Fig. 1), zone 1 (34), or zone 2 (76). We performed hybrid procedures in all patients who had aortic arch aneurysms in zones 0 and 1, and in 44.7% of patients who had zone 2 aneurysms. Commercially available thoracic endografts were used in all cases. The initial clinical success rate was 83.9% (zone 0), 85.3% (zone 1), and 90.8% (zone 2). The 30-day mortality rate was 9.7% (zone 0), 2.9% (zone 1), and 2.6% (zone 2). Zone 0 deaths were in all cases associated with intraoperative stroke (Table I). The overall type I endoleak rate was 7.8%. During follow-up, 3 cases of acute retrograde dissection were recorded. All of these patients were successfully treated with ascending aorta and aortic arch
The International Journal of Cardiovascular Imaging, 2014
International Journal of Cardiology, 2013
Aortic aneurysms (AAs) can develop in all parts of the aorta and a lot of them remain undetected ... more Aortic aneurysms (AAs) can develop in all parts of the aorta and a lot of them remain undetected unless incidentally discovered or until a lifethreatening complication occurs [1,2]. Thoracic aorta is usually studied with computed tomographic imaging (CT),magnetic resonance imaging and echocardiography [1,2]. Transthoracic echocardiography (TE) is commonly performed prior to abdominal AA (AAA) repair to evaluate the cardiac structure and function. In a recent paper, a highprevalence of thoracicAA(ATA) inpatientswithAAAassessedbyCThas been reported [3]. In our study we retrospectively enrolled 1942 patients in order to evaluate the prevalence of the ascending thoracic aortic and aortic arch dilatation/aneurysm in patients with AAA that underwent transthoracic echocardiography (TE) prior to surgery. The exclusion criteriawere: the presence of bicuspid aortic valve, previous aortic valve and/or ascending aortic surgery, genetic syndromes (Marfan syndrome, Ehlers–Danlos syndrome and others), and inflammatory and traumatic diseases. Thus, 1305 patients were considered eligible for the study. The aortic root and the proximal ascending aorta segments were visualized in the left and rightparasternal long-axis views. Inparasternal view the Valsalva sinuses and the proximal portion of the ascending aorta were measured. In the parasternal short axis bicuspid aortic valve was rule out. The aortic arch was evaluated by suprasternal view between the innominate and left carotid artery. Standardmeasurements were made by the leading edge-to-leading edge diameter in enddiastole taking care to obtain a true perpendicular dimension and appropriate gain settings [4]. Views used for measurements were those that showed the largest diameter of the aortic segment and in particular the maximum diameter measured perpendicular to the long axis of the vessel in that view. All the measurements were achieved in twodimensional mode. We used the absolute values as normal standard references of aortic sizes as follows: 1. Valsalva sinuses: 37 mm inmen and 33 inwomen; 2. Proximal ascending aorta: 34 mm inmen and 31 mm inwomen; and 3. Aortic arch: 32 mm in men and 29 mm in women. Sex-specific criteria wereused todefineanascendingaortic aneurysm:womenN42 mmand men N47 mm, and aortic arch aneurysm: women N32 mm and men N37 mm [5–7]. The study complies with the principles and guidelines of the Declaration of Helsinki. The clinical characteristics of the study population and the median diameters of the aorta are reported in Tables 1 and 2. 50% of the population had increased diameters of the Valsalva sinuses and proximal portion of ascending aorta, and 25% had the diameter of the aortic arch greater than normal range. Valsalva sinuses were increased in 25% of men and 75% of women. 50% of men and 75% of women had increased diameter of the proximal ascending aorta. The aortic arch diameter was above the normal range in 25% ofmen and 50% ofwomen. On the basis of sex-specific criteria for aneurysm4% of the patients had an ascending aortic aneurysm and 6.5% an aortic arch aneurysm. Furthermore, 2% men had an ascending aortic aneurysm compared with 25.8% of the women (p b 0.0001), and 6.6% men had an aortic arch aneurysm compared with 10.5% of the women (p b 0.4). Thus, we demonstrate a high prevalence of dilatation/aneurysm of the ascending aorta and the aortic arch in patients with AAA evaluated by TE during pre-operative risk stratification. Our study supports the common idea that ATA is commonly misdiagnosed because of its lack of symptoms. Itani et al. estimated the prevalence of asymptomatic ATA between 0.16 and 0.34% [8]. Larrson et al. evaluated the prevalence of ATA in AAA with CT scan, and they reported the presence of thoracic aorta dilatation in more than 25% of 422 patients [3]. Other retrospective studies had already assessed a higher incidence of thoracic aorta repair in patients that had previously undergone to abdominal aortic repair, although in their reports patients with connective disease were included as well. Alegret et al. stated that
European Journal of Vascular and Endovascular Surgery, 2012
![Research paper thumbnail of Corrigendum to ‘Analysis of Stroke after Tevar Involving the Aortic Arch’ [European Journal of Vascular and Endovascular Surgery 43 (2012) 269–275]](https://attachments.academia-assets.com/83652289/thumbnails/1.jpg)
](European Journal of Vascular and Endovascular Surgery, 2012
European Journal of Vascular and Endovascular Surgery, 2007
European Journal of Vascular and Endovascular Surgery, 2005
Background: Endovascular approach to the aortic arch is an appealing solution for selected patien... more Background: Endovascular approach to the aortic arch is an appealing solution for selected patients. Objective: To compare the technical and clinical success recorded in the different anatomical settings of endografting for aortic arch disease. Methods: Between June 1999 and October 2006, among 178 patients treated at our institution for thoracic aorta disease with a stent-graft, the aortic arch was involved in 64 cases. According to the classification proposed by Ishimaru, aortic zone 0 was involved in 14 cases, zone 1 in 12 cases and zone 2 in 38 cases. A hybrid surgical procedure of supra-aortic debranching and revascularization was performed in 37 cases. Results: Zone 0. Proximal neck length: 44±6 mm. Initial clinical success was 78.6%: two deaths (stroke), one type Ia endoleak. At a mean follow-up of 16.4±11 months the midterm clinical success was 85.7%. Zone 1. Proximal neck length: 28±5 mm. Initial clinical success was 66.7%: 0 deaths, four type Ia endoleaks. At a mean follow-up of 16.9±17.2 months the midterm clinical success was 75.0%. Zone 2. Proximal neck length: 30±5 mm. Initial clinical success was 84.2%: two deaths (one cardiac arrest, one multiorgan embolization), three type Ia endoleaks, one case of open conversion. Two cases of delayed transitory paraparesis/paraplegia were observed. At a mean follow-up of 28.0±17.2 months the midterm clinical success was 89.5%. Conclusions: This study and a literature review demonstrated that hybrid procedure for aortic arch pathology is feasible in selected patients at high risk for conventional surgery. Our experience is still limited by the relatively small sample size. We propose to reserve zone 1 for patients unfit for sternotomy or in cases with aortic neck length > 30 mm following left common carotid artery debranching. We recommend to perform complete aortic rerouting of the aortic arch in cases with lesser comorbidities and shorter aortic neck.
European heart journal cardiovascular Imaging, 2015
Thoracic endovascular aortic repair (TEVAR) is commonly considered as a valid alternative to surg... more Thoracic endovascular aortic repair (TEVAR) is commonly considered as a valid alternative to surgery. Endoleaks occurrence is one of the principal limitations of TEVAR. Transoesophageal echocardiography (TEE) is often adopted in adjunct to fluoroscopy and angiography (ANGIO) during stent-graft implantation. In the present study, we compare intraprocedural ANGIO, TEE, and contrast-enhanced TEE (cTEE), and we also evaluate their accuracy in early endoleaks detection and characterization. Fifty-four patients with thoracic aortic disease suitable for TEVAR were prospectively enrolled in the study. After stent placement, the result of the procedure was assessed by ANGIO, TEE, and cTEE. The use of contrast (Sonovue, Bracco) significantly improved TEE quality (P = 0.0001). cTEE was superior in entry tears, false and true lumen and aneurysm thrombosis identification, and microtears and ulcer-like projections detection before stent deployment. After stent deployment, cTEE was more accurate t...
Thoraco-Abdominal Aorta, 2011
Knowledge of the spinal cord vascular supply is important in patients undergoing procedures that ... more Knowledge of the spinal cord vascular supply is important in patients undergoing procedures that involve the thoracic and thoraco-abdominal aorta. However, the spinal cord vasculature has a complex anatomy, and teaching is often based only on anatomical sketches; historically, this has required a "leap of faith" on the part of aortic surgeons. Fortunately, this "leap of faith" is no longer necessary given recent breakthroughs in imaging technologies and post-processing software that have expanded the non-invasive diagnostic ability to determine a patient's spinal cord vascular pattern, particularly in detecting the presence and location of the artery of Adamkiewicz. Computed tomography angiography fulfils the need of vascular surgeons for preoperative assessment of spinal cord anatomy, and planning of aortic interventions and procedures.
European Journal of Vascular Surgery, 1988
Annales De Chirurgie Vasculaire, 2010
ABSTRACT Les dissections rétrogrades de type A (RTAD) ne sont pas si rares après réparation aorti... more ABSTRACT Les dissections rétrogrades de type A (RTAD) ne sont pas si rares après réparation aortique endovasculaire thoracique des dissections de type B, particulièrement en présence de désordres du tissu conjonctif. Le risque de RTAD après réparation aortique endovasculaire thoracique des anévrysmes non disséquants doit être clarifié, principalement si une atteinte proximale de la crosse impose une réparation hybride avec un clampage aortique latéral, un débranchement proximal des troncs supra-aortiques et le largage du stentgraft dans l’aorte ascendante. Nous rapportons une RTAD à moyen terme après réparation hybride d’un anévrysme non disséquant de la crosse proximale sans désordres du tissu conjonctif. La technique de remplacement de l’aorte ascendante sans ablation du stentgraft de la crosse et une revue de la littérature au sujet de cette complication mal connue sont présentées.
Journal of Vascular Surgery, 2011
Journal of Vascular Surgery, 2005
Recent studies have reported different sac behavior after endovascular repair of abdominal aortic... more Recent studies have reported different sac behavior after endovascular repair of abdominal aortic aneurysms, depending on the endografts. This study was designed to evaluate mid-term outcome and sac behavior after treatment with the Gore Excluder stent-graft. Methods: Between June 1999 and January 2005, 109 selected patients with suitable anatomy were treated electively for abdominal aortic aneurysm with the Excluder stent graft. Data were prospectively collected in a computerised database and included demographics, details of the aortoiliac anatomy, procedural and clinical success, and postoperative complications. Postoperative sac size and the presence of endoleaks were assessed with computed tomography scans obtained at 1, 6, and 12 months, and yearly thereafter. All diameter measures in patients followed for >1 year (84.4%) were analyzed. Results: Assisted primary technical success was achieved in 108 cases (99.1%). No type I endoleaks and 12 (11.1%) type II endoleaks were recorded <1 month from the procedure. Mean follow-up was 29.6 ؎ 16.1 months. We recorded one new-onset type IA endoleak, complete resolution of five type II endoleaks, and eight new-onset type II endoleaks. The overall prevalence of type II endoleaks was 14%. Shrinkage at 1, 2, 3, and 4 years was observed in 20.7%, 30.5%, 38.9%, and 36.8% of cases. The presence of type II endoleak influenced the trend of aneurysm size throughout the 4 years. Aneurysms without endoleak shrank more than aneurysms with type II endoleak (P< .0001). We observed two cases of sac enlargement due to the presence of endoleaks. No cases of endotension with sac enlargement, late open conversion, or aneurysm-related deaths were observed. Unchanged aneurysmal sacs remained stable during follow-up, with no adverse events. Conclusions: Endovascular treatment with the Excluder device in selected patients produces low rates of shrinkage, but this peculiar sac behavior does not affect mid-term clinical success.
Journal of Vascular Surgery, 2013
Journal of Vascular Surgery, 2007
Journal of Vascular Surgery, 2010
Journal of Endovascular Therapy, 2012
To report endovascular treatment of a ruptured mycotic aneurysm in a patient with previous cardia... more To report endovascular treatment of a ruptured mycotic aneurysm in a patient with previous cardiac surgery, a cardioverter-defibrillator, and an intrathoracic left ventricular assist device (LVAD). Case Report: A 75-year-old man was admitted for a syncopal episode and severe back pain. The patient had a past history of postischemic dilatative cardiomyopathy for which a cardioverter-defibrillator was implanted. An LVAD and bioprosthetic aortic valve were subsequently placed due to severe cardiogenic shock. The postoperative course was complicated by methicillin-resistant Staphylococcus aureus mediastinitis and acute renal failure requiring temporary dialysis. At the current admission 4 months later, urgent computed tomography (CT) showed a ruptured aneurysm in the middle third of the descending thoracic aorta; blood cultures were positive for Candida sp. The patient was hemodynamically stable, so he was placed in intensive care and given targeted antimicrobial therapy while an endovascular treatment was planned. At surgery, a rifampicin-soaked Relay Plus 30-mm395-cm stent-graft was deployed through a right common femoral cutdown to seal the aortic rupture. Successful aneurysm exclusion was confirmed by intraoperative transesophageal echocardiography (TEE). At the 6-month follow-up, the patient was without recurrent pathology or graft infection as demonstrated by CT. Conclusion: Thoracic endovascular aortic repair in patients with LVAD is peculiar for several aspects: accurate planning is necessary to adequately visualize the aortic lesion despite the presence of many radiopaque devices and the femoral arteries are pulseless. Moreover, extremely slow washout of contrast from the aortic rupture prevents correct assessment of final sac exclusion with angiography; intraoperative TEE monitoring proved extremely useful.
Journal of Endovascular Therapy, 2010
Journal of Endovascular Therapy, 2012
Journal of Vascular …, 2012
Background: The PETTICOAT (Provisional ExTension to Induce COmplete ATtachment) technique may be ... more Background: The PETTICOAT (Provisional ExTension to Induce COmplete ATtachment) technique may be employed during endovascular treatment of type B aortic dissection (TBD) using self-expandable bare stents distal to the covered stent graft placed over the proximal entry tear. The aim of this study is to evaluate the volume changes of the true (TL) and false lumen (FL) on computed tomography (CT) scans. Methods: Since 2005, 25 selected patients received endovascular treatment for complicated TBD with the PETTICOAT technique employing the Zenith Dissection Endovascular System (William Cook Europe, Bjaerverskov, Denmark). Indications to the use of the PETTICOAT technique were the evidence of clinical manifest dynamic malperfusion in five cases (20%) and/or radiologic evidence of TL collapse in 20 cases (80%). Five patients were treated within 2 weeks from onset, 13 patients between 2 weeks and 3 months, and seven patients over 3 months after the initial acute event. The volumetric analysis of the changes of TL and FL obtained from CT scan performed before endovascular treatment of TBD, postoperatively and yearly thereafter were analyzed using the OsiriX software v 3.9 (Pixmeo sarl, Bernex, Switzerland). Results: Initial clinical (30 days) and midterm clinical success was observed in 21 cases (84%) and in 23 cases (92%), respectively. The volumes of the aortic TL and FL were evaluated at 30 days and midterm follow-up (mean, 38 ؎ 17 months). The following TL volumes were recorded: baseline 84 ؎ 29 cm 3 , postoperative 167 ؎ 31 cm 3 (؉98%), 1 year 193 ؎ 46 cm 3 (؉131%), and 2 years 216 ؎ 54 cm 3 (؉140%). The following FL volumes were recorded: baseline 332 ؎ 86 cm 3 , postoperative 286 ؎ 85 cm 3 (؊14%), 1 year 233 ؎ 81 cm 3 (؊30%), and 2 years 248 ؎ 112 cm 3 (؊32%). Progressive remodeling of the TL was recorded over time in both thoracic and abdominal segments with shrinkage of the FL mainly in the thoracic segment. Conclusions: These data provide insight into potential therapeutic benefit of the PETTICOAT technique. A significant immediate increase in TL could be achieved with resolution of all cases of dynamic malperfusion and TL collapse. A different behavior of volumes in the thoracic and abdominal segments was observed.
Texas Heart Institute …, 2011
The European Perspective I n Europe, several indications for thoracic endovascular aortic repair ... more The European Perspective I n Europe, several indications for thoracic endovascular aortic repair (TEVAR), although still considered "off-label," have modified the way that most surgeons approach thoracic aortic disease. Among these is the so-called hybrid repair. Patients From 1999 through 2011, 387 patients underwent TEVAR in our center. Within this cohort, 141 patients with aortic arch disease (group 1) and 47 patients with thoracoabdominal aortic aneurysms (TAAA) (group 2) were considered unfit for conventional open surgery because of severe comorbidities or previous aortic interventions. As a consequence, they were selected for hybrid repair. Results Group 1. According to Ishimaru's classification scheme, we categorized 119 atherosclerotic and 22 dissecting aneurysms as zone 0 (31) (Fig. 1), zone 1 (34), or zone 2 (76). We performed hybrid procedures in all patients who had aortic arch aneurysms in zones 0 and 1, and in 44.7% of patients who had zone 2 aneurysms. Commercially available thoracic endografts were used in all cases. The initial clinical success rate was 83.9% (zone 0), 85.3% (zone 1), and 90.8% (zone 2). The 30-day mortality rate was 9.7% (zone 0), 2.9% (zone 1), and 2.6% (zone 2). Zone 0 deaths were in all cases associated with intraoperative stroke (Table I). The overall type I endoleak rate was 7.8%. During follow-up, 3 cases of acute retrograde dissection were recorded. All of these patients were successfully treated with ascending aorta and aortic arch
The International Journal of Cardiovascular Imaging, 2014
International Journal of Cardiology, 2013
Aortic aneurysms (AAs) can develop in all parts of the aorta and a lot of them remain undetected ... more Aortic aneurysms (AAs) can develop in all parts of the aorta and a lot of them remain undetected unless incidentally discovered or until a lifethreatening complication occurs [1,2]. Thoracic aorta is usually studied with computed tomographic imaging (CT),magnetic resonance imaging and echocardiography [1,2]. Transthoracic echocardiography (TE) is commonly performed prior to abdominal AA (AAA) repair to evaluate the cardiac structure and function. In a recent paper, a highprevalence of thoracicAA(ATA) inpatientswithAAAassessedbyCThas been reported [3]. In our study we retrospectively enrolled 1942 patients in order to evaluate the prevalence of the ascending thoracic aortic and aortic arch dilatation/aneurysm in patients with AAA that underwent transthoracic echocardiography (TE) prior to surgery. The exclusion criteriawere: the presence of bicuspid aortic valve, previous aortic valve and/or ascending aortic surgery, genetic syndromes (Marfan syndrome, Ehlers–Danlos syndrome and others), and inflammatory and traumatic diseases. Thus, 1305 patients were considered eligible for the study. The aortic root and the proximal ascending aorta segments were visualized in the left and rightparasternal long-axis views. Inparasternal view the Valsalva sinuses and the proximal portion of the ascending aorta were measured. In the parasternal short axis bicuspid aortic valve was rule out. The aortic arch was evaluated by suprasternal view between the innominate and left carotid artery. Standardmeasurements were made by the leading edge-to-leading edge diameter in enddiastole taking care to obtain a true perpendicular dimension and appropriate gain settings [4]. Views used for measurements were those that showed the largest diameter of the aortic segment and in particular the maximum diameter measured perpendicular to the long axis of the vessel in that view. All the measurements were achieved in twodimensional mode. We used the absolute values as normal standard references of aortic sizes as follows: 1. Valsalva sinuses: 37 mm inmen and 33 inwomen; 2. Proximal ascending aorta: 34 mm inmen and 31 mm inwomen; and 3. Aortic arch: 32 mm in men and 29 mm in women. Sex-specific criteria wereused todefineanascendingaortic aneurysm:womenN42 mmand men N47 mm, and aortic arch aneurysm: women N32 mm and men N37 mm [5–7]. The study complies with the principles and guidelines of the Declaration of Helsinki. The clinical characteristics of the study population and the median diameters of the aorta are reported in Tables 1 and 2. 50% of the population had increased diameters of the Valsalva sinuses and proximal portion of ascending aorta, and 25% had the diameter of the aortic arch greater than normal range. Valsalva sinuses were increased in 25% of men and 75% of women. 50% of men and 75% of women had increased diameter of the proximal ascending aorta. The aortic arch diameter was above the normal range in 25% ofmen and 50% ofwomen. On the basis of sex-specific criteria for aneurysm4% of the patients had an ascending aortic aneurysm and 6.5% an aortic arch aneurysm. Furthermore, 2% men had an ascending aortic aneurysm compared with 25.8% of the women (p b 0.0001), and 6.6% men had an aortic arch aneurysm compared with 10.5% of the women (p b 0.4). Thus, we demonstrate a high prevalence of dilatation/aneurysm of the ascending aorta and the aortic arch in patients with AAA evaluated by TE during pre-operative risk stratification. Our study supports the common idea that ATA is commonly misdiagnosed because of its lack of symptoms. Itani et al. estimated the prevalence of asymptomatic ATA between 0.16 and 0.34% [8]. Larrson et al. evaluated the prevalence of ATA in AAA with CT scan, and they reported the presence of thoracic aorta dilatation in more than 25% of 422 patients [3]. Other retrospective studies had already assessed a higher incidence of thoracic aorta repair in patients that had previously undergone to abdominal aortic repair, although in their reports patients with connective disease were included as well. Alegret et al. stated that
European Journal of Vascular and Endovascular Surgery, 2012
European Journal of Vascular and Endovascular Surgery, 2012
European Journal of Vascular and Endovascular Surgery, 2007
European Journal of Vascular and Endovascular Surgery, 2005
Background: Endovascular approach to the aortic arch is an appealing solution for selected patien... more Background: Endovascular approach to the aortic arch is an appealing solution for selected patients. Objective: To compare the technical and clinical success recorded in the different anatomical settings of endografting for aortic arch disease. Methods: Between June 1999 and October 2006, among 178 patients treated at our institution for thoracic aorta disease with a stent-graft, the aortic arch was involved in 64 cases. According to the classification proposed by Ishimaru, aortic zone 0 was involved in 14 cases, zone 1 in 12 cases and zone 2 in 38 cases. A hybrid surgical procedure of supra-aortic debranching and revascularization was performed in 37 cases. Results: Zone 0. Proximal neck length: 44±6 mm. Initial clinical success was 78.6%: two deaths (stroke), one type Ia endoleak. At a mean follow-up of 16.4±11 months the midterm clinical success was 85.7%. Zone 1. Proximal neck length: 28±5 mm. Initial clinical success was 66.7%: 0 deaths, four type Ia endoleaks. At a mean follow-up of 16.9±17.2 months the midterm clinical success was 75.0%. Zone 2. Proximal neck length: 30±5 mm. Initial clinical success was 84.2%: two deaths (one cardiac arrest, one multiorgan embolization), three type Ia endoleaks, one case of open conversion. Two cases of delayed transitory paraparesis/paraplegia were observed. At a mean follow-up of 28.0±17.2 months the midterm clinical success was 89.5%. Conclusions: This study and a literature review demonstrated that hybrid procedure for aortic arch pathology is feasible in selected patients at high risk for conventional surgery. Our experience is still limited by the relatively small sample size. We propose to reserve zone 1 for patients unfit for sternotomy or in cases with aortic neck length > 30 mm following left common carotid artery debranching. We recommend to perform complete aortic rerouting of the aortic arch in cases with lesser comorbidities and shorter aortic neck.