Complications and Management of the Thoracic Endovascular Aortic Repair.

Endovascular treatment in thoracic aortic diseases has increased in use exponentially since Dake and colleagues first described the use of a home-made transluminal endovascular graft on 13 patients with descending thoracic aortic aneurysm at Stanford University in the early 1990s. Thoracic endovascular aneurysm repair (TEVAR) was initially developed for therapy in patients deemed unfit for open surgery. Innovations in endograft engineering design and popularization of endovascular techniques have transformed TEVAR to the predominant treatment choice in elective thoracic aortic repair. The number of TEVARs performed in the United States increased by 600% from 1998 to 2007, while the total number of thoracic aortic repairs increased by 60%. As larger multicenter trials and meta-analysis studies in the 2000s demonstrate the significant decrease in perioperative morbidity and mortality of TEVAR over open repair, TEVAR became incorporated into standard guidelines. The 2010 American consensus guidelines recommend TEVAR to be "strongly considered" when feasible for patients with degenerative or traumatic aneurysms of the descending thoracic aorta exceeding 5.5 cm, saccular aneurysms, or postoperative pseudoaneurysms. Nowadays, TEVAR is the predominant treatment for degenerative and traumatic descending thoracic aortic aneurysm repair. Although TEVAR has been shown to have decreased early morbidity and mortality compared with open surgical repair, endovascular manipulation of a diseased aorta with endovascular devices continues to have significant risks. Despite continued advancement in endovascular technique and devices since the first prospective trial examined the complications associated with TEVAR, common complications, two decades later, still include stroke, spinal cord ischemia, device failure, unintentional great vessel coverage, access site complications, and renal injury. In this article, we review common TEVAR complications with some corresponding radiographic imaging and their management.

Double Valve-in-Valve Transcatheter Valve Replacements for Failed Surgical Bioprosthetic Aortic and Tricuspid Valves.

Transcatheter technology has revolutionized the treatment of valvular disease in the field of cardiology and cardiac surgery. We present an interesting case of a patient with prior double valve replacements, which had degenerated after a decade, with symptoms of decompensated heart failure. The patient was successfully treated with double valve-in-valve transcatheter aortic and tricuspid valve replacement.

Massive thoracic ganglioneuroma with significant mass effect on left hemithorax.

A 42-year-old, otherwise healthy, woman presented with persistent left-sided chest pain. A chest X-ray revealed a large opacity in the left hemithorax which prompted further investigation with an MRI. MRI revealed a large left apical mass occupying approximately two-thirds of the left hemithorax. The mass was investigated further with a CT with contrast which did not reveal any vascular involvement or invasion into adjacent structures. The patient successfully underwent tumour resection via left thoracotomy. The tumour was removed in its entirety. Grossly, the tumour was a 23×10×10 cm, well encapsulated, ovoid, fibrous nodule. Histopathology revealed ganglion cells, nerve fibres and Schwann cells in a mucous matrix consistent with ganglioneuroma. Postoperative course was unremarkable.