Chest-Wall Necrosis After Aortic Aneurysm Repair

Interactive CardioVascular and Thoracic Surgery, 2012

OBJECTIVES: This study was carried out to determine whether the myocutaneous flap, alone, is sufficient to reconstruct a chest wall defect after osteoradionecrosis and provide satisfactory stability to the chest wall. METHODS: This study involved five patients who were subjected to post-mastectomy radiotherapy as a treatment for breast cancer. Excision of the ulcer and all the necrotic ribs, with preservation of the parietal pleura and reconstruction with the latissimus dorsi flap, was done without the use of either an artificial prosthesis or autologous rib to reconstruct the chest wall defect. RESULTS: Clinical and radiological follow-up showed no complications regarding respiratory impairment or pleural complications. CONCLUSIONS: The use of myocutaneous flap in patients with chest wall defect following osteoradionecrosis is satisfactory to cover the chest wall defect and provide satisfactory stability to the chest wall.

The Annals of Thoracic Surgery, 2014

Aortic Aneurysm - Clinical Findings, Diagnostic, Treatment and Special Situations, 2021

Aortic aneurysm repair is a common procedure and may be performed in an open or endovascular fashion, It is important to be aware that there exist many potential hazards associated with aortic aneurysm repair. The fact that this entity can be treated in an open or in an endovascular fashion increases the complexity of the problems that may arise. To begin there exists the inherent risks associated with any surgical procedures in the high-risk patient including bleeding, infection, cardiovascular and respiratory issues that may arise. Complications can also occur in the acute or delayed setting and can present several months or even years after repair. Aneurysms may form in the abdominal or thoracic aorta and each segment has its own unique set of issues that may present after repair. Experience and knowledge of associated problems is imperative for early recognition and best outcomes.

Annals of cardiothoracic surgery, 2012

Annals of Vascular Surgery, 2005

Seventeen patients treated for infected grafts (11/17) or aneurysms (6/17) of the aorta between 1998 and 2003 were reviewed to evaluate our experience with aortic infection. The causative organisms were identified in 12 patients (71%), with 5 (29%) having methicillin-resistant Staphylococcus aureus. A periaortic abscess occurred in eight patients, and all of them were associated with infected grafts. Surgical treatment included cryopreserved allograft replacement in eight patients, prosthetic graft replacement in four patients, and drainage with or without omental wrapping in five patients. One patient was still hospitalized at the end of the study period. Five patients with infected grafts died after the operation during the initial hospitalization. No early mortality occurred in the aneurysm group. The early mortality rate was 31% for all patients, 50% for the graft group, and 63% for patients with a periaortie abscess. Another patient with an infected aneurysm died of arrhythmia after discharge from the initial hospitalization, Ten patients are still alive without evidence of reinfection. The early mortality rate for patients with infected aortic grafts is higher than that for those with infected aneurysms, especially when a periaortic abscess accompanies them. However, the late outcome is favorable, with no reinfection or late treatment-related deaths.

Journal of Endovascular Therapy, 2003

To retrospectively determine the value of stent-graft repair of descending thoracic aortic aneurysms by analyzing the results and complications. Methods: From May 1997 to July 2002, 45 patients (33 men; mean age 69 years, range 31-88) received endovascular treatment for thoracic aortic aneurysms. In 11 patients, emergency treatment was necessary for a contained rupture. The medical records of these patients were reviewed to gather data on the procedures, immediate results, complications, mortality, and survival in follow-up. Results: In all cases, the stent-grafts were successfully implanted. In 15 (33%) cases, the subclavian artery was covered by the stent-graft without complications. There was no paraparesis/paraplegia; 2 (4.4%) patients suffered a stroke intraoperatively. The in-hospital mortality was 2.2% (nϭ1); 3 (6.7%) patients died within 30 days. Primary endoleaks occurred in 8 (17.8%) cases. Procedural success (technical success without endoleak or death) was 80% (93.3% after primary endoleak repair). During follow-up, 2 (4.4%) secondary endoleaks developed. All endoleaks were treated successfully or sealed spontaneously (nϭ2). At a mean 24-month follow-up (range 1-62), 84% of patients were alive. Conclusions: The endovascular treatment of thoracic aortic aneurysms appears to be safe and effective, with lower morbidity and mortality than in conventional open operations. For these reasons, endovascular treatment should be administered whenever possible.

International Journal of Angiology, 2009

Journal of Vascular Surgery, 2003

Purpose: Unlike abdominal aortic aneurysm repair, little information exists regarding aortic-related morbidity (synchronous/metachronous aneurysm or graft-related complications) after thoracoabdominal aneurysm (TAA) repair. This study was performed to define such events and identify factors related to their development. Methods: Over a 15-year interval, 333 patients underwent TAA repair (type I, n ‫؍‬ 90; 27%; type II, n ‫؍‬ 59; 18%; type III, n ‫؍‬ 118; 35%; and type IV, n ‫؍‬ 66; 20%). Late aortic events were defined as aortic disease causing death or necessitating further intervention or graft-related complications (infection, pseudoaneurysm, branch occlusion) after hospital discharge. Variables were assessed for their association with aortic events with Cox proportional hazards regression. Results: In-hospital mortality occurred in 28 patients (8.4%), which left 305 available for follow-up (mean length of follow-up, 26 months; interquartile range, 2.7 to 38.4 months). After TAA repair, aneurysm remained in 60 patients (19.7%; ascending/arch, n ‫؍‬ 41; 68.3%; discontinuous infrarenal, n ‫؍‬ 12; 20%; contiguous descending, n ‫؍‬ 7; 11.7%; contiguous abdominal, n ‫؍‬ 4; 6.7%). Events occurred in 33 individuals (10.8%) at 30 ؎ 27 months after surgery. Twenty-four patients (73% of events; 7.9% of cohort) had aortic-related events, including another elective aneurysm repair (n ‫؍‬ 16), urgent/emergent aneurysm operation (n ‫؍‬ 5), acute dissection (n ‫؍‬ 2), and atherothrombotic embolization (n ‫؍‬ 1). Nine patients (27% of events; 2.9% of cohort) had graft-related incidents, including renovisceral occlusion (n ‫؍‬ 5), visceral patch pseudoaneurysm (n ‫؍‬ 2), graft infection (n ‫؍‬ 2), and graft-esophageal fistula (n ‫؍‬ 1). Variables independently predictive of events were female gender (odds ratio [OR], 2.3; P ‫؍‬ .03), initial aneurysm rupture (OR, 4.8; P ‫؍‬ .04), partial disease resection (OR, 4.2; P ‫؍‬ .0008), and expansion of remaining aortic segments on imaging surveillance (OR, 2.5; P ‫؍‬ .03). The event-free survival rates were 96% (95% CI, 93% to 98%) and 71% (95% CI, 60% to 83%) at 1 and 5 years. Conclusion: Late aortic events occur in at least 10% of patients after TAA repair and are usually the result of native aortic disease in remote (or noncontiguous) aortic segments. Graft-related complications, in particular, degeneration of inclusion anastamoses, are rare. Female gender, original presentation with rupture, and unresected disease identify those at highest risk. These findings verify the anatomic durability of TAA repair and suggest indefinite aortic surveillance is indicated for those at risk of events. (J Vasc Surg 2003;37:254-61.) From the Divisions of Vascular Surgery a and Vascular Anesthesia b and the