title: Endovascular strategies for treatment of embolizing thoracoabdominal aortic lesions.
abstract: OBJECTIVE
  Aortic sources of peripheral and visceral embolization remain challenging to treat. The safety of stent graft coverage continues to be debated. This study reports the outcomes of stent coverage of these complex lesions.
  
  
  METHODS
  Hospital records were retrospectively reviewed for patients undergoing aortic stenting between 2006 and 2013 for visceral and peripheral embolic disease. Renal function, method of coverage, and mortality after stent grafting were reviewed.
  
  
  RESULTS
  Twenty-five cases of embolizing aortic lesions treated with an endovascular approach were identified. The mean age was 65 ± 13 years (range, 45-87 years), and 64% were female. Sixteen (64%) patients presented with peripheral embolic events, six with concomitant renal embolization. Five patients presented with abdominal or flank pain, and two were discovered incidentally. Three patients had undergone an endovascular procedure for other indications within the preceding 6 months of presentation. Nineteen patients had existing chronic kidney disease (stage II or higher), but only three had stage IV disease. Of the eight patients tested, four had a diagnosed hypercoagulable state. Eight of the patients had lesions identified in multiple aortic segments, and aortic aneurysm disease was present in 24%. Coverage of both abdominal and thoracic sources occurred in eight patients, whereas 17 had only one segment covered. Minimal intraluminal catheter and wire manipulation was paired with the use of intravascular ultrasound in an effort to reduce embolization and contrast use. Intravascular ultrasound was used in the majority of cases and transesophageal echo in 28% of patients. Two patients with stage IV kidney disease became dialysis-dependent within 3 months of the procedure. No other patients had an increase in their postoperative or predischarge serum creatinine levels. No embolic events were precipitated during the procedure, nor were there any recurrent embolic events detected on follow-up. The 1-year mortality rate was 25%.
  
  
  CONCLUSIONS
  Endovascular coverage of atheroembolic sources in the aorta is feasible and is safe and effective in properly selected patients. It does not appear to worsen renal function when performed with the use of specific technical strategies.
authors.affiliation: University of Pittsburgh Medical Center, Pittsburgh, Pa. Electronic address: jeyabalang@upmc.edu.
authors.forename: Geetha
authors.initials: G
authors.lastname: Jeyabalan
authors.affiliation: University of Pittsburgh Medical Center, Pittsburgh, Pa.
authors.forename: Justin R
authors.initials: JR
authors.lastname: Wallace
authors.affiliation: University of Pittsburgh Medical Center, Pittsburgh, Pa.
authors.forename: Rabih Antoine
authors.initials: RA
authors.lastname: Chaer
authors.affiliation: University of Pittsburgh Medical Center, Pittsburgh, Pa.
authors.forename: Steven A
authors.initials: SA
authors.lastname: Leers
authors.affiliation: University of Pittsburgh Medical Center, Pittsburgh, Pa.
authors.forename: Luke Keith
authors.initials: LK
authors.lastname: Marone
authors.affiliation: University of Pittsburgh Medical Center, Pittsburgh, Pa.
authors.forename: Michel S
authors.initials: MS
authors.lastname: Makaroun
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D017545:Aortic Aneurysm, Thoracic / Q000150:complications / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D001027:Aortography / Q000379:methods; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation / Q000401:mortality; D019091:Critical Pathways; D004617:Embolism / Q000175:diagnosis / Q000209:etiology / Q000401:mortality / Q000601:surgery*; D057510:Endovascular Procedures / Q000009:adverse effects / Q000295:instrumentation / Q000401:mortality; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011474:Prosthesis Design; D012189:Retrospective Studies; D012307:Risk Factors; D015607:Stents; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional