[Intraoperative transesophageal echocardiography in the endovascular treatment of thoracic aortic aneurysms].
OBJECTIVE
Endovascular surgery is an efficacious alternative to conventional surgery in the treatment of descending thoracic aorta aneurysms. However, primary and delayed endoleaks are some endovascular technology's weak points. They are usually detected by angiography or angio CT, but many information may be obtained by transesophageal echocardiography (TEE) both as to endoleaks and to endograft's correct placement. Our purpose is to confirm, on the basis of our experience, the validity of this technique chosen both by us and by other groups with a wider casuistry.


METHODS
We positioned endografts for the treatment of degenerative or post-traumatic aneurysms of the descending thoracic aorta using TEE, together with angiography, during surgery in 8 out of 9 patients. TEE was carried out on the same 8 patients also before surgery, and for some patients even in the follow-up together with angio CT, after 6 and 12 months.


RESULTS
In the situations where TEE was used we found 5 cases of endoleaks and 1 of these was not detected by angiography because of its small dimensions. All of these endoleaks were immediately corrected with more angioplasty or graft extensions; in a case, where we could not utilize the TEE, the problem solved spontaneously after 30 days as it was confirmed both by angiography and angio TC. The statistical analysis with the Student t test is significant for P < 0.005.


CONCLUSIONS
We think that using TEE during the placement of an endograft on the descending thoracic aorta may help to obtain useful information in addition to those that we can obtain with angiography. Therefore, this may lead to improve the technique and to reduce possible both immediate or delayed complications.
U.O. di Chirurgia Vascolare, Azienda Ospedaliera Ospedale di Busto Arsizio Busto Arsizio, Varese, Italy. fabiochierichetti@libero.it
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Chierichetti
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Costantini
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Campanati
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Miglierina
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Tori
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017130:Angioplasty; D017545:Aortic Aneurysm, Thoracic / Q000000981:diagnostic imaging* / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation / Q000379:methods*; D017548:Echocardiography, Transesophageal; D006801:Humans; D007430:Intraoperative Care; D008297:Male