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Off-label use of thoracic aortic endovascular stent grafts to simplify difficult resections and procedures in general thoracic surgery

Walgram, Tanja ; Attigah, Nicolas ; Schwegler, Igor ; Weber, Markus ; Dzemali, Omer ; Berthold, Christian ; Wagnetz, Dirk ; Carboni, Giovanni L.

In: Interactive CardioVascular and Thoracic Surgery, 2018, vol. 26, no. 4, p. 545-550

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    Titre
    • Off-label use of thoracic aortic endovascular stent grafts to simplify difficult resections and procedures in general thoracic surgery
    Auteur
    • Walgram, Tanja. Division of Thoracic Surgery, Department of Surgery, Triemli Hospital Zurich, Switzerland
    • Attigah, Nicolas. Division of Vascular Surgery, Department of Surgery, Triemli Hospital Zurich, Switzerland
    • Schwegler, Igor. Division of Vascular Surgery, Department of Surgery, Triemli Hospital Zurich, Switzerland
    • Weber, Markus. Division of Visceral Surgery, Department of Surgery, Triemli Hospital Zurich, Switzerland
    • Dzemali, Omer. Division of Cardiac Surgery, Department of Surgery, Triemli Hospital Zurich, Switzerland
    • Berthold, Christian. Division of Interventional Radiology, Department of Radiology, Triemli Hospital Zurich, Switzerland
    • Wagnetz, Dirk. Division of Thoracic Surgery, Department of Surgery, Triemli Hospital Zurich, Switzerland
    • Carboni, Giovanni L.. Division of Thoracic Surgery, Department of Surgery, Triemli Hospital Zurich, Switzerland
    Type de document
    • Postprint
    Langue
    • Anglais
    Publié dans
    • Interactive CardioVascular and Thoracic Surgery, 2018, vol. 26, no. 4, p. 545-550. Oxford University Press
    Autre version électronique
    Identifiant OAI-PMH
    • oai:doc.rero.ch:332197
    Summary
    Abstract OBJECTIVES Tumour infiltration, or gross infectious involvement of the thoracic aortic wall, poses a significant intraoperative risk for fatal bleeding and therefore could compromise adequate resection or efficient surgical management of pleural infection in a considerable amount of cases. We present 3 successful cases of off-label thoracic aortic endografting to safeguard thoracic aortic wall integrity. METHODS After all patients received thoracic stent grafts through femoral access into the descending aorta, the first patient underwent a resection of a locally advanced squamous cell carcinoma of the left inferior lobe cT4cN0-1cM0 after neoadjuvant chemoradiation, which had infiltrated the descending aortic wall. The second case was video-assisted thoracoscopic bilateral pleural decortication for empyema with aortic ulcers of the distal thoracic aorta in a patient with pancreatic intrathoracic fistula in a necrotizing pancreatitis. The third patient was operated for a locally advanced squamous cell carcinoma of the left inferior lobe initial stage cT4 cN1-2 cM0 after neoadjuvant chemoradiation, which had broad contact to the descending aorta at the level of thoracic vertebrae 7 and 8 on a circumference of circa 180°. Regional ethics committee approval according the Swiss Federal Human Research Act was obtained according to regulations. RESULTS Preventive stent graft placement resulted in complication-free resection and significantly minimized the risk of fatal intraoperative bleeding. Patients were thus not exposed to complications associated with aortic cross-clamping, possible prosthetic replacement and extracorporeal circulation techniques. CONCLUSIONS In carefully selected patient populations, the resection of locally advanced tumours or infectious processes involving the aortic wall can be facilitated by thoracic endovascular aortic repair prior to resection.