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

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.

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