Publication Date
4-1-2019
Journal
The Texas Heart Institute Journal
DOI
10.14503/THIJ-17-6558
PMID
31236076
Publication Date(s)
April 2019
Language
English
PMCID
PMC6555279
PubMedCentral® Posted Date
4-1-2019
PubMedCentral® Full Text Version
Post-Print
Published Open-Access
yes
Keywords
Aged, Anesthesia, Local, Aorta, Thoracic, Aortic Aneurysm, Thoracic, Aortography, Blood Vessel Prosthesis, Computed Tomography Angiography, Conscious Sedation, Endovascular Procedures, Humans, Male, Middle Aged, Minimally Invasive Surgical Procedures
Copyright
This work is licensed under a Creative Commons Attribution-NonCommercial-No Derivative Works 4.0 International License.
Abstract
Ascending thoracic aortic aneurysm (ATAA) is typically treated surgically. No commercially available device has been specifically designed for endovascular ATAA repair, and currently, multiple anatomic and technical challenges affect its feasibility. Previously, such repairs have been performed with the patients under general anesthesia. We describe a novel, minimally invasive approach to endovascular repair of ATAA, involving local anesthesia, conscious sedation, and 24-hour hospitalization. Two consecutive male patients (ages, 79 and 54 yr) who had comorbidities underwent percutaneous transfemoral endovascular ATAA repair with use of commercially available endografts. Patient 1 had a saccular aneurysm, and Patient 2 had a pseudoaneurysm consequent to recent surgical ATAA repair. The patients were discharged from the hospital 24 hours after technically successful, uncomplicated procedures. At 2 months, computed tomograms showed no endoleak or stent-graft migration. Our experience shows that minimally invasive endovascular ATAA repair is feasible for selected high-risk patients. We describe the procedure, access and closure devices, and challenges associated with this approach.