title: Customized CT angiogram planning for intraoperative transesophageal echography-guided endovascular exclusion of thoracic aorta penetrating ulcer.
abstract: The technique is demonstrated in a 78-year-old man; the preoperative CT angiogram showed a descending thoracic aorta ulcer of 5.9 cm in maximum diameter and 3.8 cm longitudinal extension. A ZTEG-2P-36-127-PF (Cook Medical) single tubular endograft was planned to be deployed. From the preoperative CT angiogram we planned to land 4.7 cm above the midline of the descending thoracic aorta ulcer and 8.0 cm below. In the operating room, under radioscopic vision the centre of the transesophageal echography probe was used as marker to identify the correspondent midline of the descending thoracic aorta ulcer and a centimeter-sized pigtail catheter in the aorta was used to calculate the desired length above and below the ulcer midline. The endograft was introduced and placed in the desired position compared to the transesophageal echography probe and the catheter; under transesophageal echography vision the graft was finally deployed. The CT angiogram at 1 month showed the correct endograft position, descending thoracic aorta ulcer exclusion with no signs of endoleak. In selected cases, this method allows planning in advance safe stent graft positioning and deployment totally assisted by transesophageal echography, with no risk of periprocedural contrast-related renal failure and reduced radiation exposure for the patient and operators.
authors.affiliation: Vascular and Endovascular Surgery Clinic, Padova University School of Medicine, Padova, Italy mikpia79@hotmail.com.
authors.forename: Michele
authors.initials: M
authors.lastname: Piazza
authors.affiliation: Echocardiography Service Clinic of Cardiology, Padova University School of Medicine, Padova, Italy.
authors.forename: Mario
authors.initials: M
authors.lastname: Lupia
authors.affiliation: Vascular and Endovascular Surgery Clinic, Padova University School of Medicine, Padova, Italy.
authors.forename: Franco
authors.initials: F
authors.lastname: Grego
authors.affiliation: Vascular and Endovascular Surgery Clinic, Padova University School of Medicine, Padova, Italy.
authors.forename: Michele
authors.initials: M
authors.lastname: Antonello
mesh_terms: D000368:Aged; D000792:Angiography / Q000379:methods; D001013:Aorta, Thoracic / Q000000981:diagnostic imaging* / Q000601:surgery*; D001018:Aortic Diseases / Q000601:surgery*; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000379:methods; D006801:Humans; D008297:Male; D015607:Stents; D014057:Tomography, X-Ray Computed / Q000379:methods; D014456:Ulcer / Q000000981:diagnostic imaging / Q000601:surgery*
keywords: Transesophageal echography; penetrating aortic ulcer; thoracic endovascular aneurysm repair