Indications

Abdominal Aorta

Repair of Abdominal Aortic Aneurysm (AAA) (see Abdominal Aortic Aneurysm, [[Abdominal Aortic Aneurysm]])

• Indications
  • Repair of Aortic Aneurysm in Setting Where Anticoagulation/Extracorporeal Support (i.e. Cardiopulmonary Bypass) is Contraindicated

Thoracic Aorta

Repair of Thoracic Aortic Intramural Hematoma/Penetrating Aortic Ulcer

• xxx

Repair of Thoracic Aortic Dissection (see Aortic Dissection, [[Aortic Dissection]])

• xxxx

Repair of Blunt Thoracic Aortic Injury (see Blunt Aortic Injury, [[Blunt Aortic Injury]])

• xxx

Repair of Thoracic Aortic Aneurysm (TAA) (see Thoracic Aortic Aneurysm, [[Thoracic Aortic Aneurysm]])

• xxxx

Repair of Thoracic Aortoesophageal Fistula

• xxx

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Physiology

• xxx

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Technique

Types of Devices

• Gore cTAG device
• Cook TX2 endograft
• Medtronic Valiant endograft
• Bolton Relay endograft

XXXX

• xxxx

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Adverse Effects/Complications

Cardiovascular Adverse Effects/Complications

• Endograft Collapse
  • Epidemiology
    • More Frequently Occurs in Young Patients with Pliable Aortas and an Endograft Which Does Not Fully Appose the Inner Curve of the Aorta
      • Force of Cardiac Contraction Can Collapse the Endograft, Leading to an Acute Aortic Coarctation
    • Has Been Described with the Gore TAG Device After Removal of the Longitudinal Spine: this removal results in a less rigid endograft
    • Endograft Collapse May Occur within 24 hrs-3 mo After Aortic Endograft Placement
  • Physiology
    • Aortic Occlusion Resulting in Spinal Cord Ischemia-Infarction/Distal Hypoperfusion
  • Clinical
    • Acute Kidney Injury (AKI) (see Acute Kidney Injury, [[Acute Kidney Injury]]): due to renal hypoperfusion
    • Chest Pain (see Chest Pain, [[Chest Pain]])
    • Lower Extremity Weakness (see Weakness, [[Weakness]]): due to spinal cord ischemia/infarction
  • Treatment
    • Insertion of Another Endograft within the Current Graft
    • Palmaz Stenting within the Endograft
    • Open Surgical Endograft Removal
• Endograft Device Migration
  • Epidemiology: may occur
• Endograft Limb Kinking/Occlusion
• Endoleak
  • Epidemiology: occurs in 3.9-15.3% of thoracic endograft cases
  • Physiology: due to persistent blood flow within the aneurysmal sac
  • Diagnosis: detected by CT scan
  • Clinical
    • Usually Asymptomatic
    • Back Pain/Flank Pain (see Back Pain, [[Back Pain]] and Flank Pain, [[Flank Pain]])
    • Symptoms Related to Aortic Rupture
  • Clinical Classification:
    • Type I
    • Type II
    • Type III
    • Type IV
    • Type V
• Separation of Endograft Components

Gastrointestinal Adverse Effects/Complications

• Colonic Ischemia (see Colonic Ischemia, [[Colonic Ischemia]])
  • Epidemiology
  • Physiology: colonic ischemia
• Intestinal Ischemia (see Acute Mesenteric Ischemia, [[Acute Mesenteric Ischemia]])
  • Epidemiology
  • Physiology: small intestinal ischemia
• Pelvic Ischemia
  • Physiology

Infectious Adverse Effects/Complications

• Endograft Infection
  • Epidemiology: occurs in 0.4-3% of cases
  • Prognosis: 25%

Neurologic Adverse Effects/Complications

• Cerebrovascular Ischemia
  • Epidemiology
    • XXX
  • Clinical
    • XXX
• Spinal Cord Infarction (see Spinal Cord Infarction, [[Spinal Cord Infarction]])
  • Epidemiology
    • Incidence: 3-11% of cases (comparable to the rate of open surgery)
    • Risk Factors
      • Extent of Thoracic Aortic Coverage: greatest risk factor
      • Perioperative Hypotension
      • Long Procedure Duration
      • Visceral Artery Reimplantation
      • Renal Insufficiency
  • Physiology: occlusion of spinal intercostal arteries

Renal Adverse Effects/Complications

• Acute Kidney Injury (AKI) (see Acute Kidney Injury, [[Acute Kidney Injury]])
  • Physiologic Mechanisms
    • Cholesterol Emboli Syndrome (see Cholesterol Emboli Syndrome, [[Cholesterol Emboli Syndrome]]): see below
    • Contrast Nephropathy (see xxxx, [[xxxx]])
    • Renal Ischemia: see below
• Renal Ischemia
  • Physiology
    • Impingement of Endograft on Renal Artery Origin
    • Renal Artery Dissection
    • Renal Artery Embolism
    • Renal Artery Thrombosis

Rheumatologic/Orthopedic Adverse Effects/Complications

• Acute Limb Ischemia (see Acute Limb Ischemia, [[Acute Limb Ischemia]])
  • Epidemiology: xxxx
  • Physiology: lower extremity ischemia is usually due to endograft limb occlusion

Other Adverse Effects/Complications

• Cholesterol Emboli Syndrome (see Cholesterol Emboli Syndrome, [[Cholesterol Emboli Syndrome]])
• Postimplantation Syndrome
  • Epidemiology
    • May Occur During the Early Postoperative Period
  • Physiology
    • Endothelial Activation by the Endograft
    • Increased IL-6 and TNFα
  • Clinical
    • Elevated C-Reactive Protein (see xxxx, [[xxxx]])
    • Fever (see xxxx, [[xxxx]])
    • Leukocytosis (see xxxx, [[xxxx]])
    • Reactive Unilateral/Bilateral Pleural Effusion(s) (see xxxx, [[xxxx]]): occurs frequently with thoracic endografts (occurs in 37-73% of cases)

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References

• Endovascular treatment of thoracic aortic aneurysms: results of the phase II multi-center trial of the Gore TAG thoracic endoprosthesis. J Vasc Surg 2005;41:1–9
• Endovascular repair of thoracic aortic tears. Ann Thorac Surg 2006;82: 873– 8
• Endovascular management of traumatic ruptures of the thoracic aorta: a retrospective multi-center analysis of 28 cases in the Netherlands. J Vasc Surg 2006;43:1096–102
• Endovascular repair of proximal endograft collapse after treatment for thoracic aortic disease. J Vasc Surg 2006;43:609–12
• Anatomic factors associated with acute endograft collapse after Gore TAG treatment of thoracic aortic dissection or traumatic rupture. J Vasc Surg 2007;45:655–61
• Operative strategy for open surgery after failed thoracic aortic stent grafting. J Thorac Cardiovasc Surg 2007;134:1044 – 6
• Endograft collapse after thoracic stent-graft repair for traumatic rupture. Ann Thorac Surg. 2009;87(5):1582-1583 [MEDLINE]
• Great vessel and cardiac trauma. Surg Clin North Am. 2009 Aug;89(4):797-820, viii. doi: 10.1016/j.suc.2009.05.002 [MEDLINE]