PDF(Pubmed)
Abstract：
UNASSIGNED: Penetrating aortic ulcers (PAUs) are the rarest subset of acute aortic syndromes, and a thoraco-abdominal (TA) location is uncommon. Endovascular surgery is considered first line treatment. Custom made branched/fenestrated endografts have been successfully applied in this disease but are unavailable in the urgent setting. Off the shelf solutions may be required in high risk patients. The case of a symptomatic rapidly expanding TA-PAU without a distal seal zone that underwent urgent endovascular repair is described.
UNASSIGNED: An 81 year old male presented with acute intense thoracic pain. Workup revealed a large TA-PAU. As pain was refractory and computed tomography angiography confirmed rapid expansion, urgent repair was proposed. Due to multiple comorbidities and absence of adequate distal seal zone, an off label endovascular treatment was proposed. The patient underwent successful endovascular repair with two aortic stent grafts (GORE cTAG) with 30% oversize and 50-55 mm overlap between modules, combined with chimney self expanding stent grafts (GORE VIABAHN) to the coeliac trunk and superior mesenteric artery in a sandwich configuration. The post-operative course was uneventful. Follow up at 18 months revealed no endoleaks and patent bridging stent grafts without visceral compromise.
UNASSIGNED: Thoracic endovascular aortic repair (TEVAR) is considered the first treatment option for urgent PAU. However, anatomic requirements limit its use in the thoraco-abdominal aorta. Parallel graft techniques have been described to overcome these anatomic constraints in TA aneurysms. The use of a \"sandwich technique\" to successfully exclude a PAU without a distal sealing zone for standard TEVAR is described. The advantage was limited aortic coverage compared with a branched device or an \"octopus\" technique. This solution is particularly useful in urgent situations when patients cannot wait for a custom made device and the morbidity associated with open or hybrid repair is unacceptably high. An off the shelf sandwich technique is a potential safe and long lasting therapeutic option for the urgent treatment of TA-PAU.
UNASSIGNED: An 81 year old male presented with acute intense thoracic pain. Workup revealed a large TA-PAU. As pain was refractory and computed tomography angiography confirmed rapid expansion, urgent repair was proposed. Due to multiple comorbidities and absence of adequate distal seal zone, an off label endovascular treatment was proposed. The patient underwent successful endovascular repair with two aortic stent grafts (GORE cTAG) with 30% oversize and 50-55 mm overlap between modules, combined with chimney self expanding stent grafts (GORE VIABAHN) to the coeliac trunk and superior mesenteric artery in a sandwich configuration. The post-operative course was uneventful. Follow up at 18 months revealed no endoleaks and patent bridging stent grafts without visceral compromise.
UNASSIGNED: Thoracic endovascular aortic repair (TEVAR) is considered the first treatment option for urgent PAU. However, anatomic requirements limit its use in the thoraco-abdominal aorta. Parallel graft techniques have been described to overcome these anatomic constraints in TA aneurysms. The use of a \"sandwich technique\" to successfully exclude a PAU without a distal sealing zone for standard TEVAR is described. The advantage was limited aortic coverage compared with a branched device or an \"octopus\" technique. This solution is particularly useful in urgent situations when patients cannot wait for a custom made device and the morbidity associated with open or hybrid repair is unacceptably high. An off the shelf sandwich technique is a potential safe and long lasting therapeutic option for the urgent treatment of TA-PAU.
摘要：
未经证实：穿透性主动脉溃疡（PAUs）是急性主动脉综合征中最罕见的亚组，胸腹（TA）位置并不常见。血管内手术被认为是一线治疗。定制的分支/有孔的内移植物已成功应用于这种疾病，但在紧急情况下无法使用。高风险患者可能需要现成的解决方案。描述了有症状的快速扩张的TA-PAU，没有远端密封区，并进行了紧急血管内修复。
未经证实：一名81岁男性出现急性剧烈胸痛。检查显示了一个大的TA-PAU。由于疼痛难治，计算机断层扫描血管造影证实快速扩张，建议紧急修理。由于多种合并症和没有足够的远端密封区，提出了一种标签外血管内治疗。患者接受了两个主动脉支架（GOREcTAG）成功的腔内修复术，其中30％过大，模块之间重叠50-55mm，结合烟囱自扩张支架移植物（GOREVIABAHN），以夹层结构将腹腔干和肠系膜上动脉。术后过程顺利。在18个月的随访中发现没有内漏和专利桥接支架移植物，没有内脏损害。
UNASSIGNED：胸主动脉腔内修复术（TEVAR）被认为是紧急PAU的第一治疗选择。然而,解剖要求限制了其在胸腹主动脉中的使用。已经描述了并行移植技术来克服TA动脉瘤中的这些解剖约束。描述了使用“三明治技术”成功排除标准TEVAR没有远端密封区的PAU。与分支装置或“章鱼”技术相比，优势是主动脉覆盖范围有限。当患者不能等待定制的装置并且与开放式或混合修复相关的发病率高得不可接受时,该解决方案在紧急情况下特别有用。现成的三明治技术是紧急治疗TA-PAU的潜在安全且持久的治疗选择。
未经证实：一名81岁男性出现急性剧烈胸痛。检查显示了一个大的TA-PAU。由于疼痛难治，计算机断层扫描血管造影证实快速扩张，建议紧急修理。由于多种合并症和没有足够的远端密封区，提出了一种标签外血管内治疗。患者接受了两个主动脉支架（GOREcTAG）成功的腔内修复术，其中30％过大，模块之间重叠50-55mm，结合烟囱自扩张支架移植物（GOREVIABAHN），以夹层结构将腹腔干和肠系膜上动脉。术后过程顺利。在18个月的随访中发现没有内漏和专利桥接支架移植物，没有内脏损害。
UNASSIGNED：胸主动脉腔内修复术（TEVAR）被认为是紧急PAU的第一治疗选择。然而,解剖要求限制了其在胸腹主动脉中的使用。已经描述了并行移植技术来克服TA动脉瘤中的这些解剖约束。描述了使用“三明治技术”成功排除标准TEVAR没有远端密封区的PAU。与分支装置或“章鱼”技术相比，优势是主动脉覆盖范围有限。当患者不能等待定制的装置并且与开放式或混合修复相关的发病率高得不可接受时,该解决方案在紧急情况下特别有用。现成的三明治技术是紧急治疗TA-PAU的潜在安全且持久的治疗选择。
