For the first time, as part of the new session “CX Meets Latin America”, Latin American physicians shared their experiences of treating abdominal aortic and thoraco-aortic aneurysm with CX delegates.
At the session entitled “Pushing the boundaries of EVAR and TEVAR”, CX delegates received information on case reports from Argentina, Brazil and Puerto Rico. Frank Criado, Baltimore, USA, chaired the session with Frans Moll, Utretcht, The Netherlands, and Tulio Navarro, Belo Horizonte, Brazil, as moderators.
Mariano Ferreira, Buenos Aires, Argentina, presented a case of a 74-year-old man with a 7cm thoraco-abdominal aneurysm with distal dilatation of the aortic arch that was treated in a three-staged thoracic endovascular aortic repair (TEVAR) procedure. Ferreira said: “Due to elevated spinal cord ischaemic risk, a three-staged TEVAR procedure was planned with prophylactic left subclavian artery revascularisation.”
He explained that the patient underwent TEVAR under general anaesthetic with adjunctive spinal fluid drainage. “Through a direct right femoral access, three Gore Tag thoracic endoprostheses (40 x 140mm, 37 x 200mm and 34 x 200mm) were implanted in an overlapping proximal-to-distal fashion covering the entire length of the thoraco-aortic aneurysm (from the left common carotid artery origin to the celiac axis trunk).”
Ferreira commented that the patient did not present any complications after the procedure and was discharged home on the fourth postoperative day. He added: “Twelve days later, the patient underwent successful percutaneous proximal left subclavian plug embolization to guarantee complete sealing of the thoraco-abdominal aneurysm.” After one-year follow-up, Ferreira concluded, a CT scan revealed complete exclusion of the thoraco-abdominal aneurysm.
A case of a “Hybrid treatment of ascending aorta and arch without opening the chest wall” was presented by Tulio Navarro, Belo Horizonte, Brazil. He said: “The treatment of the aortic arch is one of the greatest challenges to the surgeon. The conventional open repair requires sternotomy and cardiopulmonary bypass. In order to reduce complications, the use of endovascular techniques has been shown to be feasible.”
For this case, Navarro described an alternative approach to ascending aorta, arch and descending aorta with off-the-shelf devices without opening the chest wall. He said: “A 71-year-old male underwent a right-to-left carotid-carotid bypass graft. Using this access, a 16x16x95mm Medtronic limb extension was placed at the ascending aorta, and then a 44x44x200mm TEVAR Valiant-Captivia endograft was also placed at the ascending aorta distal to the limb extension, via right femoral artery.” According to Navarro, the patient tolerated the procedure well and was discharged after three days, asymptomatic and with no stroke. He told the audience that after 17 months of follow-up, the patient was still alive and remained asymptomatic, with no sequels, no strokes and that all grafts were patent.
Navarro also presented a second case, which was of a 58-year-old female with prior type A dissection and who was operated on five years ago. He explained that she presented with hoarseness and chest discomfort. According to Navarro, the CT scan showed an 8cm aortic arch aneurysm affecting all supraortic vessels and chronic dissection going down below visceral aorta. She was treated the same way as the previous case. After four months of follow-up, Navarro commented, there was still remaining hoarseness but no chest discomfort and CT scan did not show any leaks. This technique, Navarro concluded: “allows the treatment of aortic arch diseases without opening the chest wall with off-the-shelf devices with good results.”
However, this alternative approach should only be performed only in high-risk patients and needs to be evaluated with long-term results and larger series.
Also, at the session, several challenging cases from Brazil were presented—endovascular treatment of complex type IV aneurysm by Pierre Galvagni Silveira, Florianopolis, Brazil; a not suitable neck abdominal aortic aneurysm treated by physician fenestrated endograft by Gustavo Puludetto, Brasilia, Brazil; an endovascular treatment of aortic pseudoaneurysm by Alvaro Razuk, Sao Paulo, Brazil; and a case of ascending aorta treated by a heart and vascular team (Eduardo Saadi, Porto Alegre , Brazil).
Criado closed the session saying: “This is a good beginning of CX Meets Latin America; we hope that this will become a feature of CX making it better and bigger with more room for participants and more speakers from other Latin American countries.”