P1015Essential role of intraoperative transesophageal echocardiography in endovascular repair of thoracic aortic dissection. Eleven cases review. Single centre experience.


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Abstract

Purpose: Thoracic aortic dissection constitutes a highly fatal clinical emergency. Transesophageal echocardiography represents a sensitive, non-invasive, bed-side imaging modality for thoracic aortic disease. Percutaneous stentgraft deployment offers a clinically and technically efficient, low-morbidity, low-mortality, low-complication rate alternative to open repair of thoracic aortic dissection. We review our experience with intraoperative use of TEE for thoracic endovascular aortic repair (TEVAR).Methods and Materials: Eleven TEVAR procedures were performed in general anesthesia using real-time TEE to identify the extent of the aneurysmal sac, depict dissection entry and exit zone, aid endograft positioning, to detect early flow within the aneurysmal sac immediately after stentgraft deployment.Results: All our TEVAR procedures were technically and clinically successful, no complications occurred. Real time TEE has shown to be a valuable tool for visualization and quantification of aortic pathology, confirming guide wire placement into the true lumen, aiding stent-graft positioning (assuring that it covers the dissection entry and exit zone and adheres properly to the aortic wall), representing the most sensitive imaging modality for endoleaks detection immediately after the endograft placement.Conclusion: Real-time intraoperative TEE has in our centre proved to be an essential imaging tool for thoracic aortic dissection precisely identifying its true extent. Supplementing fluoroscopy, TEE has significantly increases TEVAR's safety, accuracy, and efficacy through providing fast and complete pathomorphological information, improving spatial orientation, allowing continuous monitoring of the procedures and thus improving their outcomes and not less importantly lowering radiation dose and contrast material use.

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