Jerzy Kulesza

Stent grafts separation 6 years after endovascular repair of a thoracic aortic aneurysm.

the thoracoabdominal aorta with stent-grafts can cause paraplegia. In conclusion, we performed embolization of a PGL with coils and NBCA by using a TCCS through the pseudolumen in a retrograde fashion. We consider that this is a feasible and useful treatment method for patients who have undergone debranching TEVAR with a chimney graft for postsurgical expansion of a dissecting thoracic aneurysm.

Post-traumatic acute thoracic aortic injury (TAI)—a single center experience

Background We assess the effectiveness and our experience in emergency thoracic endovascular aortic repair (TEVAR) in patients with post-traumatic acute thoracic aortic injury (TAI) and associated multiorgan trauma. TAI is a life-threatening condition. It usually results from a sudden deceleration caused by vehicle accident, a fall or some other misfortune. Techniques of endovascular aortic repair have become promising methods to treat emergent TAI. Methods Since 2007, 114 patients with thoracic aorta pathologies have been treated by TEVAR. Our study involved 15 (incl. 14 men) of them (13%) who underwent stent graft implantation for post-traumatic either aortic rupture or pseudoaneurysm. The procedural access was limited to small skin incision in one groin and percutaneous puncture of the contralateral femoral artery. We evaluated technical success, early and long-term mortality, complication rate of procedure and throughout clinical and instrumental follow-up. Results Technical success rate was 100%. All patients survived the endovascular interventions. No additional procedures or conversions to open surgery were necessary. After the operation, none of the patients had symptoms of stroke or spinal cord ischemia (SCI). No serious stent-graft-related adverse events such as endoleak, infection or migration were noted during follow-up period that ranged from 6 to 108 months. Conclusions In our department, techniques of TEVAR with stentgraft implantation have become methods of choice in treatment of traumatic TAIs since they have enabled to minimize operational risk, particularly in unstable multitrauma patients in severe clinical status. TEVAR for TAI performed in emergency settings provide favorable long-term results.

Pregnancy and childbirth in a patient after multistep surgery and endovascular treatment of cardiovascular disease

Abstract Nowadays physicians see an increasing population of patients reaching reproductive age after surgery for complex congenital heart defects. Correction of congenital and acquired cardiovascular defects does not exclude experiencing a safe pregnancy. We present the case of a 27-year-old woman, who, after multistep surgery and endovascular treatment of her cardiovascular system, underwent successful pregnancy and uncomplicated childbirth. Recent developments in medicine and interdisciplinary involvement have allowed women with corrected cardiovascular disease the opportunity to become pregnant and experience safe childbirth.

Endovascular treatment of renal artery occlusion caused by aortic stentgraft migration.

Renal function impairment during interventional procedures became a real clinical problem. Contrast related nephropathy is the most common cause of renal failure, however, the procedure-related technical troubles may cause unexpected renal dysfunction.Technical failure of EVAR resulting in acute renal dysfunction is presented. The postprocedural occlusion of the right renal artery was treated in chimney technique. Early reintervention allowed the kidney preservation and renal function restoration. It is impossible to avoid all the complications following treatment of aortic aneurysm, but they can be anticipated and comprehensively treated in collaboration with other specialists.

Fenestrated stent graft in treatment of type IV thoracoabdominal aneurysm involving all visceral arteries.

Conventional open surgical repair of thoracoabdominal aortic aneurysm (TAAA) is associated with high perioperative mortality and morbidity risk. Our report of successful treatment of a 56-year-old patient with TAAA involving all visceral arteries and with many comorbidities with a fenestrated stent graft supports its application in high-risk TAAA patients.

New Technique for the Preservation of the Left Common Carotid Artery in Zone 2a Endovascular Repair of Thoracic Aortic Aneurysm

To describe a technique for the preservation of the left common carotid artery (CCA) in zone 2 endovascular repair of thoracic aortic aneurysm. This technique involves the placement of a guide wire into the left CCA via the right brachial artery before stent graft deployment to enable precise visualization and protection of the left CCA during the whole procedure. Of the 107 patients with thoracic endovascular aortic repair in our study, 32 (30%) had the left subclavian artery intentionally covered (landing zone 2). Eight (25%) of those 32 had landing zone 2a—the segment distally the origin of the left CCA, halfway between the origin of the left CCA and the left subclavian artery. In all patients, a guide wire was positioned into the left CCA via the right brachial artery before stent graft deployment. It is a retrospective study in design. In seven patients, stent grafts were positioned precisely. In the remaining patient, the positioning was imprecise; the origin of the left CCA was partially covered by the graft. A stent was implanted into the left CCA to restore the flow into the vessel. All procedures were performed successfully. The technique of placing a guide wire into the left CCA via the right brachial artery before stent graft deployment is a safe and effective method that enables the precise visualization of the left CCA during the whole procedure. Moreover, in case of inadvertent complete or partial coverage of the origin of the left CCA, it supplies safe and quick access to the artery for stent implantation.