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Title: Late Pseudocoarctation Syndrome After Stent-Graft Implantation For Traumatic Aortic Rupture

Abstract

The present observation illustrates an unusual complication occurring after stent-grafting (S-graft) for aortic isthmus rupture. A 22-year-old patient, treated by S-graft in the emergency department for traumatic aortic rupture, was readmitted 10 months later with pseudocoarctation syndrome. A membrane was found inside the stent-graft that had induced a pseudo-dissection, which caused the pseudocoarctation syndrome. Surgical treatment consisted of removing the stent-graft and membrane and replacing it with a vascular implant. The patient's clinical course was fair. The suggested mechanism was circumferential neoendothelialization of the stent-graft. Dehiscence caused the superior part of the membrane to drop into the lumen of the stent-graft creating a 'false channel' that compressed the 'true lumen' and induced 'pseudocoarctation' syndrome. The cause of the extensive neointimalization remains unexplained. Thoracic aortic stent-grafts require regular follow-up monitoring by angioscan or angio-magnetic resonance imaging.

Authors:
; ;  [1];  [2]; ;  [1];  [3];  [1]
  1. University Hospital of Nantes, Institut du Thorax (France)
  2. University Hospital of Nantes, Department of Pathology (France)
  3. University Hospital of Toulouse, Department of Radiology (France)
Publication Date:
OSTI Identifier:
22113669
Resource Type:
Journal Article
Resource Relation:
Journal Name: Cardiovascular and Interventional Radiology; Journal Volume: 36; Journal Issue: 3; Other Information: Copyright (c) 2013 Springer Science+Business Media New York and the Cardiovascular and Interventional Radiological Society of Europe (CIRSE); Article Copyright (c) 2012 Springer Science+Business Media, LLC and the Cardiovascular and Interventional Radiological Society of Europe (CIRSE); Country of input: International Atomic Energy Agency (IAEA)
Country of Publication:
United States
Language:
English
Subject:
62 RADIOLOGY AND NUCLEAR MEDICINE; ACCIDENTS; BIOMEDICAL RADIOGRAPHY; GRAFTS; IMPLANTS; NMR IMAGING; PATIENTS; SURGERY

Citation Formats

Letocart, Vincent, E-mail: vincent.letocart@chu-nantes.fr, Fau, Georges, E-mail: georges.fau@chu-nantes.fr, Tirouvanziam, Ashok, E-mail: ashok.tirouvanziam@chu-nantes.fr, Toquet, Claire, E-mail: claire.toquet@chu-nantes.fr, Al Habash, Oussama, E-mail: oussama.alhabash@chu-nantes.fr, Guerin, Patrice, E-mail: patrice.guerin@chu-nantes.fr, Rousseau, Herve, E-mail: rousseau.h@chu-toulouse.fr, and Crochet, Dominique, E-mail: dominique.crochet@chu-nantes.fr. Late Pseudocoarctation Syndrome After Stent-Graft Implantation For Traumatic Aortic Rupture. United States: N. p., 2013. Web. doi:10.1007/S00270-012-0436-7.
Letocart, Vincent, E-mail: vincent.letocart@chu-nantes.fr, Fau, Georges, E-mail: georges.fau@chu-nantes.fr, Tirouvanziam, Ashok, E-mail: ashok.tirouvanziam@chu-nantes.fr, Toquet, Claire, E-mail: claire.toquet@chu-nantes.fr, Al Habash, Oussama, E-mail: oussama.alhabash@chu-nantes.fr, Guerin, Patrice, E-mail: patrice.guerin@chu-nantes.fr, Rousseau, Herve, E-mail: rousseau.h@chu-toulouse.fr, & Crochet, Dominique, E-mail: dominique.crochet@chu-nantes.fr. Late Pseudocoarctation Syndrome After Stent-Graft Implantation For Traumatic Aortic Rupture. United States. doi:10.1007/S00270-012-0436-7.
Letocart, Vincent, E-mail: vincent.letocart@chu-nantes.fr, Fau, Georges, E-mail: georges.fau@chu-nantes.fr, Tirouvanziam, Ashok, E-mail: ashok.tirouvanziam@chu-nantes.fr, Toquet, Claire, E-mail: claire.toquet@chu-nantes.fr, Al Habash, Oussama, E-mail: oussama.alhabash@chu-nantes.fr, Guerin, Patrice, E-mail: patrice.guerin@chu-nantes.fr, Rousseau, Herve, E-mail: rousseau.h@chu-toulouse.fr, and Crochet, Dominique, E-mail: dominique.crochet@chu-nantes.fr. 2013. "Late Pseudocoarctation Syndrome After Stent-Graft Implantation For Traumatic Aortic Rupture". United States. doi:10.1007/S00270-012-0436-7.
@article{osti_22113669,
title = {Late Pseudocoarctation Syndrome After Stent-Graft Implantation For Traumatic Aortic Rupture},
author = {Letocart, Vincent, E-mail: vincent.letocart@chu-nantes.fr and Fau, Georges, E-mail: georges.fau@chu-nantes.fr and Tirouvanziam, Ashok, E-mail: ashok.tirouvanziam@chu-nantes.fr and Toquet, Claire, E-mail: claire.toquet@chu-nantes.fr and Al Habash, Oussama, E-mail: oussama.alhabash@chu-nantes.fr and Guerin, Patrice, E-mail: patrice.guerin@chu-nantes.fr and Rousseau, Herve, E-mail: rousseau.h@chu-toulouse.fr and Crochet, Dominique, E-mail: dominique.crochet@chu-nantes.fr},
abstractNote = {The present observation illustrates an unusual complication occurring after stent-grafting (S-graft) for aortic isthmus rupture. A 22-year-old patient, treated by S-graft in the emergency department for traumatic aortic rupture, was readmitted 10 months later with pseudocoarctation syndrome. A membrane was found inside the stent-graft that had induced a pseudo-dissection, which caused the pseudocoarctation syndrome. Surgical treatment consisted of removing the stent-graft and membrane and replacing it with a vascular implant. The patient's clinical course was fair. The suggested mechanism was circumferential neoendothelialization of the stent-graft. Dehiscence caused the superior part of the membrane to drop into the lumen of the stent-graft creating a 'false channel' that compressed the 'true lumen' and induced 'pseudocoarctation' syndrome. The cause of the extensive neointimalization remains unexplained. Thoracic aortic stent-grafts require regular follow-up monitoring by angioscan or angio-magnetic resonance imaging.},
doi = {10.1007/S00270-012-0436-7},
journal = {Cardiovascular and Interventional Radiology},
number = 3,
volume = 36,
place = {United States},
year = 2013,
month = 6
}
  • No abstract prepared.
  • No abstract prepared.
  • Thoracic and abdominal aortic endovascular procedures as alternatives to aortic reoperations were studied in three different cases. An anastomotic aneurysm after previous thoracic aortic graft for coarctation, a second-stage elephant trunk repair (descending thoracic aortic aneurysm), and a secondary aneurysm proximal to a previous abdominal aortic graft were successfully treated with endovascular stent-grafts. During the follow-up period no lethal events or major aortic or graft-related complications were observed, except a type II endoleak in the anastomotic aortic aneurysm case. An endovascular stent-graft can be safely deployed into a previously implanted vascular graft, avoiding repeat surgery.
  • Purpose: To present the computed tomographic (CT) imaging findings and their relevance to clinical outcomes related to stent graft placement in patients with penetrating aortic ulcers (PAUs). Methods: Medical and imaging records and imaging studies were reviewed for consecutive patients who underwent stent graft repair of a PAU. The distribution and characteristics of the PAU, technical success of stent graft repair, procedure-related complications, associated aortic wall abnormalities, and outcomes of the PAUs at follow-up CT scans were evaluated. Results: Fifteen patients underwent endovascular treatment for PAU. A total of 87% of the PAUs were in the proximal (n = 8)more » or distal (n = 5) descending thoracic aorta. There was a broad spectrum of PAU depth (mean, 7.9 {+-} 5.6 mm; range 1.5-25.0 mm) and diameter (mean, 13.5 {+-} 9.7 mm; range 2.2-41.0 mm). Atherosclerosis of the thoracic aorta and intramural hematoma were associated in 53 and 93% of the patients, respectively. Technical success was achieved in 100%. Two or more stent grafts were used in five patients. Endoleaks were observed in two patients within 2 weeks of the procedure, both of which resolved spontaneously. At follow-up CT scanning, regression and thrombosis of the PAUs were observed in all patients. The average patient survival was 61.8 months, with an overall mortality of 13% (2 of 15) at follow-up. Neither death was related to the endograft device or the PAU. Conclusion: Endovascular stent graft placement was safe and effective in causing regression and thrombosis of PAUs in this small series of patients. Two or more stent grafts were used in five patients (33%) with associated long-segmental atherosclerotic changes of the thoracic aorta or intramural hematoma.« less
  • A 78-year-old man presented with a 7-cm aneurysm in the left superficial femoral artery, which was considered unfit and anatomically unsuitable for conventional open surgery for multiple comorbidities. The patient was treated with stent-graft [Viabhan stent-graft (WL Gore and Associates, Flagstaff, AZ)]. Two years from stent-graft implantation, the patient presented a purulent secretion and a spontaneous external expulsion through a fistulous channel. No claudication symptoms or hemorrhagic signs were present. The pus and device cultures were positive for Staphylococcus aureus sensitive to piperacillin/tazobactam. Patient management consisted of fistula drainage, systemic antibiotic therapy, and daily wound dressing. At 1-month follow-up, themore » wound was closed. To our knowledge, this is the first case of this type of stent-graft complication presenting with external expulsion.« less