551
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Guo B, Hou K, Guo D, Xu X, Shi Z, Shan Y, Lv P, Fu W. Outcomes of thoracic endovascular repair for type B aortic dissection with multichanneled morphology. J Vasc Surg 2017; 66:1007-1017. [DOI: 10.1016/j.jvs.2016.12.145] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2016] [Accepted: 12/27/2016] [Indexed: 01/16/2023]
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552
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Schoenhoff F, Zanchin C, Czerny M, Makaloski V, Gahl B, Carrel T, Schmidli J. Aorta Related and All-cause Mortality in Patients with Aortic Intramural Haematoma. Eur J Vasc Endovasc Surg 2017; 54:447-453. [DOI: 10.1016/j.ejvs.2017.07.001] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2017] [Accepted: 07/02/2017] [Indexed: 01/16/2023]
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553
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Comparison of intravascular ultrasound- and centerline computed tomography-determined aortic diameters during thoracic endovascular aortic repair. J Vasc Surg 2017. [DOI: 10.1016/j.jvs.2017.03.445] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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554
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Choo SJ. Treatment of uncomplicated acute type B aortic dissection in the endovascular era: is it time for a paradigm shift? J Thorac Dis 2017; 9:3450-3452. [PMID: 29268312 DOI: 10.21037/jtd.2017.09.05] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Affiliation(s)
- Suk Jung Choo
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
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555
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Aortic Dissection and Severe Renal Failure 6 Years After Kidney Transplantation. Transplant Direct 2017; 3:e202. [PMID: 28894790 PMCID: PMC5585418 DOI: 10.1097/txd.0000000000000723] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2017] [Accepted: 07/14/2017] [Indexed: 11/25/2022] Open
Abstract
We report the case of a patient with long-term history of hypertension, presenting with transient neurological disorders and severe graft failure several years after kidney transplantation. Cause of end-stage renal disease was hypertensive nephrosclerosis. Chronic hemodialysis lasted for 1 year. After transplantation and throughout follow-up, serum creatinine ranged from 200 to 230 μmol/L and maintenance immunosuppression included sirolimus and low-dose steroids. Six years after transplantation, the patient presented with right hip pain radiating to the lower back, transient aphasia, confusion, and hemiparesis. Surprisingly, progressive anuria was established requiring dialysis. After numerous nonconclusive investigations including renal histology, a contrast computed tomography scan discovered a Stanford B aortic dissection from the left common carotid artery and left subclavian artery to bilateral internal and external iliac arteries, including the right femoral artery. No surgical treatment was opted and hemodialysis, tight control of blood pressure and oral anticoagulation were established. Immunosuppression was lightened to low-dose steroids alone. After 8 months, chronic dialysis was stopped, and today, 22 months after the diagnosis of aortic dissection, the patient is doing well with a still functioning graft (creatinine, 377 μmol/L; modification of diet in renal disease-glomerular filtration rate, 15 mL/min), and without any other immunosuppression than low-dose steroids.
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556
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Yuan X, Mitsis A, Tang Y, Nienaber CA. The IRAD and beyond: what have we unravelled so far? Gen Thorac Cardiovasc Surg 2017; 67:146-153. [PMID: 28879585 DOI: 10.1007/s11748-017-0817-6] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Accepted: 08/08/2017] [Indexed: 12/13/2022]
Abstract
Acute aortic dissection is a life-threatening condition associated with high morbidity and mortality rates and a long history of challenges to both diagnose and manage this condition successfully. The International Registry of Acute Aortic Dissection (IRAD) was established in 1996 as a global database to understand this old disease better and improve care for dissection. IRAD initially targeted various areas including etiological factors of dissection, modes of presentation, clinical features, physical findings, imaging, management, and outcomes, and is currently branching out in more specific fields such as endovascular intervention, genetic profiling, and functional imaging. Although presenting symptoms and physical findings have not changed significantly over two decades, the widespread use of computed tomography is standard and has improved the diagnostic pathway. Moreover, more patients are managed with appropriate procedures, such as surgery in type A, and endovascular therapy in subsets of type B aortic dissection. With these ongoing improvements in swift diagnostic work-up and therapeutic care, fewer patients are not getting appropriate treatment and more patients survive once they reach hospital.
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Affiliation(s)
- Xun Yuan
- Cardiology and Aortic Centre, Royal Brompton and Harefield NHS Trust and Imperial College, Sydney Street, London, SW3 6NP, UK
| | - Andreas Mitsis
- Cardiology and Aortic Centre, Royal Brompton and Harefield NHS Trust and Imperial College, Sydney Street, London, SW3 6NP, UK
| | - Yida Tang
- Department of Internal Medicine, Coronary Heart Disease Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Christoph A Nienaber
- Cardiology and Aortic Centre, Royal Brompton and Harefield NHS Trust and Imperial College, Sydney Street, London, SW3 6NP, UK.
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557
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Implantation of Unibody Single-Branched Stent Graft for Patients with Type B Aortic Dissections Involving the Left Subclavian Artery: 1-Year Follow-Up Outcomes. Cardiovasc Intervent Radiol 2017; 40:1678-1686. [DOI: 10.1007/s00270-017-1748-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Accepted: 07/13/2017] [Indexed: 10/18/2022]
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558
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Shimizu H, Hirahara N, Motomura N, Miyata H, Takamoto S. Current status of cardiovascular surgery in Japan, 2013 and 2014: a report based on the Japan Cardiovascular Surgery Database 5. Thoracic aortic surgery. Gen Thorac Cardiovasc Surg 2017; 65:671-678. [DOI: 10.1007/s11748-017-0822-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Accepted: 08/25/2017] [Indexed: 11/29/2022]
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559
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Fleerakkers J, Schepens M. How should we manage type B aortic dissections? Gen Thorac Cardiovasc Surg 2017; 67:154-160. [PMID: 28852959 DOI: 10.1007/s11748-017-0818-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2017] [Accepted: 08/17/2017] [Indexed: 12/16/2022]
Abstract
Dissection of the descending aorta is a serious and potentially lethal event. Treatment options consist of medical therapy, open surgical replacement of the affected aorta and thoracic endovascular repair. In acute cases, medical treatment is started initially. When complicated, endovascular repair is generally considered as first choice treatment, except for connective tissue disorders where open surgery remains the standard. In stable, uncomplicated patients with risk factors for future aortic growth pre-emptive endovascular repair should be considered in the sub-acute phase of the dissection. The treatment strategy in chronic dissections is somewhat debated. Long-term results and aortic remodeling of endovascular repair are disappointing and open surgery remains the standard.
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Affiliation(s)
- J Fleerakkers
- Department of Cardiac Surgery, AZ Sint-Jan, Ruddershove 10, 8000, Brugge, Belgium.
| | - M Schepens
- Department of Cardiac Surgery, AZ Sint-Jan, Ruddershove 10, 8000, Brugge, Belgium
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560
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Luo S, Ding H, Luo J, Li W, Ning B, Liu Y, Huang W, Xue L, Fan R, Chen J. Risk factors and early outcomes of acute renal injury after thoracic aortic endograft repair for type B aortic dissection. Ther Clin Risk Manag 2017; 13:1023-1029. [PMID: 28860786 PMCID: PMC5566893 DOI: 10.2147/tcrm.s131456] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Background Thoracic endovascular aortic repair (TEVAR) has become an emerging treatment modality for acute type B aortic dissection (TBAD) patients in recent years. The risk factors and impacts of acute kidney injury (AKI) after percutaneous TEVAR, however, have not been widely established. Methods We retrospectively studied the clinical records of 305 consecutive patients who admitted to our institution and had TEVAR for TBAD between December 2009 and June 2013. The patients were routinely monitored for their renal functions preoperatively until 7 days after TEVAR. The Kidney Disease Improving Global Guidelines (KDIGO) criteria were used for AKI. Results Of the total 305 consecutive patients, 84 (27.5%) developed AKI after TEVAR, comprising 66 (21.6%) patients in KDIGO stage 1, 6 (2.0%) patients in stage 2 and 12 (3.9%) patients in stage 3. From the logistic regression analysis, systolic blood pressure (SBP) on admission >140 mmHg (odds ratio [OR], 2.288; 95% CI, 1.319–3.969) and supra-aortic branches graft bypass hybrid surgery (OR, 3.228; 95% CI, 1.526–6.831) were independent risk factors for AKI after TEVAR. Local anesthesia tended to be a protective factor (OR, 0.563; 95% CI, 0.316–1.001). The preoperative renal function, angiotensin-converting enzyme inhibitor/angiotensin receptor blocker or statin administration, volume of contrast agent, range of TBAD and false lumen involving renal artery were not associated with post-operation AKI. The in-hospital mortality and major adverse events were markedly increased with the occurrence of AKI (7.1% vs 0.9%, P=0.006; 14.3% vs 3.2%, P<0.001, respectively). Conclusions TEVAR for TBAD has a high incidence of AKI, which is associated with worse in-hospital outcomes. SBP on admission and supra-aortic branches graft bypass hybrid surgery were the most significant risk factors. Renopreventive measures should be considered in high-risk patients.
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Affiliation(s)
- Songyuan Luo
- Cardiology Department, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China
| | - Huanyu Ding
- Cardiology Department, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China
| | - Jianfang Luo
- Cardiology Department, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China
| | - Wei Li
- Cardiology Department, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China
| | - Bing Ning
- Cardiology Department, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China
| | - Yuan Liu
- Cardiology Department, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China
| | - Wenhui Huang
- Cardiology Department, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China
| | - Ling Xue
- Cardiology Department, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China
| | - Ruixin Fan
- Cardiology Department, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China
| | - Jiyan Chen
- Cardiology Department, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China
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561
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Sultan I, Wallen TJ, Habertheuer A, Siki M, Arnaoutakis GJ, Bavaria J, Szeto WY, Milewski R, Vallabhajosyula P. Concomitant antegrade stent grafting of the descending thoracic aorta during transverse hemiarch reconstruction for acute DeBakey I aortic dissection repair improves aortic remodeling. J Card Surg 2017; 32:581-592. [DOI: 10.1111/jocs.13192] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Ibrahim Sultan
- University of Pittsburgh Medical Center; Pittsburgh Pennsylvania
| | | | | | - Mary Siki
- University of Pennsylvania Medical Center; Philadelphia Pennsylvania
| | | | - Joseph Bavaria
- University of Pennsylvania Medical Center; Philadelphia Pennsylvania
| | - Wilson Y. Szeto
- University of Pennsylvania Medical Center; Philadelphia Pennsylvania
| | - Rita Milewski
- University of Pennsylvania Medical Center; Philadelphia Pennsylvania
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562
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Abai B. Invited commentary. J Vasc Surg 2017; 66:385-386. [DOI: 10.1016/j.jvs.2017.02.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2017] [Accepted: 02/03/2017] [Indexed: 10/19/2022]
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563
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Zhang MH, Du X, Guo W, Liu XP, Jia X, Ge YY. Early and midterm outcomes of thoracic endovascular aortic repair (TEVAR) for acute and chronic complicated type B aortic dissection. Medicine (Baltimore) 2017; 96:e7183. [PMID: 28700467 PMCID: PMC5515739 DOI: 10.1097/md.0000000000007183] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
Thoracic endovascular aortic repair (TEVAR) in the current era has been chosen as a dominant and minimally invasive treatment for complicated aorta dissection. This study aimed to assess safety and feasibility of TEVAR in acute and chronic type B aortic dissection.Between January 2011 and December 2013, 85 patients with complicated type B aortic dissection undergoing TEVAR were divided into acute aortic dissection (AAD) (n = 60) group and chronic aortic dissection (CAD) group (n = 25). Computed tomography was used to evaluate postoperative changes in maximal aortic diameter and true and false lumen diameters at 3 levels during a mean follow-up period of 26.4 ± 15.6 months.The technical success rate was 100%. In-hospital and 30-day rates of death were 3.3% in acute group and 0 in chronic group. Postdischarge rates of type I leak, type II leak, and retrograde type A dissection were 6.7%, 5.2%, and 3.4% (acute) and 0%, 4.0%, and 4.0% (chronic), respectively. The maximal aorta diameter remained stable in all the 3 levels in both acute and chronic group. The cumulative freedom from all-cause mortality at 3 years was similar in acute and chronic groups (89.5% vs 95.5%, P = .308). The cumulative freedom from aortic-related mortality was also not significantly different in the acute and chronic groups (92.8% vs 95.2%, P = .531). In the thoracic aorta, TEVAR treatment resulted in a significant increase in true lumen (TL) diameter and decrease in false lumen (FL). However, in the abdominal aorta, TEVAR did not lead to significant change in TL and FL diameters. The rates of complete thrombosis thoracic false lumens were better than that in the abdominal false lumen.TEVAR was a safe and effect therapy for complicated acute and chronic type B dissection with low early and mid-term mortality and morbidity.
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564
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Kamman AV, Jonker FH, Sechtem U, Harris KM, Evangelista A, Montgomery DG, Patel HJ, Eagle KA, Trimarchi S. Predictors of Stable Aortic Dimensions in Medically Managed Acute Aortic Syndromes. Ann Vasc Surg 2017; 42:143-149. [DOI: 10.1016/j.avsg.2017.01.012] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Revised: 12/27/2016] [Accepted: 01/23/2017] [Indexed: 01/16/2023]
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565
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Asaloumidis N, Karkos CD, Trellopoulos G, Konstantinidis K, Giagtzidis IT, Kalogirou TE, Papazoglou KO. Outcome after Endovascular Repair of Subacute Type B Aortic Dissection: A Combined Series from Two Greek Centers. Ann Vasc Surg 2017; 42:136-142. [DOI: 10.1016/j.avsg.2016.09.023] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Revised: 09/11/2016] [Accepted: 09/12/2016] [Indexed: 01/16/2023]
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566
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Pulsatile Flow Leads to Intimal Flap Motion and Flow Reversal in an In Vitro Model of Type B Aortic Dissection. Cardiovasc Eng Technol 2017; 8:378-389. [DOI: 10.1007/s13239-017-0312-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2017] [Accepted: 05/24/2017] [Indexed: 02/04/2023]
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567
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Schäfers HJ. Toward a more rational approach in treating type B aortic dissection. J Thorac Cardiovasc Surg 2017; 154:1201-1202. [PMID: 28587879 DOI: 10.1016/j.jtcvs.2017.05.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2017] [Accepted: 05/05/2017] [Indexed: 11/29/2022]
Affiliation(s)
- Hans-Joachim Schäfers
- Department of Thoracic and Cardiovascular Surgery, Saarland University Medical Center, Homburg/Saar, Germany.
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568
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Redfern E, Callaway M, Zakkar M, Bryan AJ. Improving outcomes in acute aortic dissection. Br J Hosp Med (Lond) 2017; 78:320-326. [DOI: 10.12968/hmed.2017.78.6.320] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Affiliation(s)
- Emma Redfern
- Consultant in Accident and Emergency, Department of Accident and Emergency, Bristol Royal Infirmary, Bristol BS2 8HW
| | - Mark Callaway
- Consultant Radiologist, Department of Radiology, Bristol Royal Infirmary, Bristol
| | - Mustafa Zakkar
- Academic Clinical Lecturer in Cardiac Surgery, Department of Cardiac Surgery, Bristol Royal Infirmary, Bristol
| | - Alan J Bryan
- Consultant Cardiac Surgeon, Department of Cardiac Surgery, Bristol Royal Infirmary, Bristol
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569
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Boufi M, Patterson BO, Grima MJ, Karthikesalingam A, Hudda MT, Holt PJ, Loftus IM, Thompson MM. Systematic Review of Reintervention After Thoracic Endovascular Repair for Chronic Type B Dissection. Ann Thorac Surg 2017; 103:1992-2004. [DOI: 10.1016/j.athoracsur.2016.12.036] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Revised: 12/14/2016] [Accepted: 12/19/2016] [Indexed: 10/19/2022]
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570
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Aortic Remodeling After Endovascular Repair of Complicated Acute Type B Aortic Dissection. Ann Thorac Surg 2017; 103:1878-1885. [DOI: 10.1016/j.athoracsur.2016.09.057] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2016] [Revised: 09/07/2016] [Accepted: 09/12/2016] [Indexed: 11/18/2022]
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571
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Iafrancesco M, Goebel N, Mascaro J, Franke UF, Pacini D, Di Bartolomeo R, Weiss G, Grabenwöger M, Leontyev SA, Mohr FW, Sioris T, Jakob H, Tsagakis K. Aortic diameter remodelling after the frozen elephant trunk technique in aortic dissection: results from an international multicentre registry†. Eur J Cardiothorac Surg 2017; 52:310-318. [PMID: 28575324 DOI: 10.1093/ejcts/ezx131] [Citation(s) in RCA: 58] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2015] [Accepted: 12/20/2016] [Indexed: 11/14/2022] Open
Affiliation(s)
- Mauro Iafrancesco
- Department of Cardiothoracic Surgery, University Hospital Birmingham NHS Foundation Trust, Birmingham, UK
| | - Nora Goebel
- Department of Cardiac and Vascular Surgery, Robert Bosch Hospital, Stuttgart, Germany
| | - Jorge Mascaro
- Department of Cardiothoracic Surgery, University Hospital Birmingham NHS Foundation Trust, Birmingham, UK
| | - Ulrich F.W. Franke
- Department of Cardiac and Vascular Surgery, Robert Bosch Hospital, Stuttgart, Germany
| | - Davide Pacini
- Department of Cardiac Surgery, Sant’Orsola-Malpighi Hospital, Bologna, Italy
| | | | - Gabriel Weiss
- Department of Cardiovascular Surgery, Hospital Hietzing, Vienna, Austria
| | - Martin Grabenwöger
- Department of Cardiovascular Surgery, Hospital Hietzing, Vienna, Austria
| | - Sergey A. Leontyev
- Department of Cardiac Surgery, Leipzig Heart Center, University of Leipzig, Leipzig, Germany
| | - Friedrich-Wilhelm Mohr
- Department of Cardiac Surgery, Leipzig Heart Center, University of Leipzig, Leipzig, Germany
| | - Thanos Sioris
- Tampere University Hospital Heart Center, Tampere, Finland
| | - Heinz Jakob
- Department of Thoracic and Cardiovascular Surgery, West German Heart Centre Essen, University Hospital Essen, Essen, Germany
| | - Konstantinos Tsagakis
- Department of Thoracic and Cardiovascular Surgery, West German Heart Centre Essen, University Hospital Essen, Essen, Germany
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572
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Abstract
Stanford type B aortic dissections (TBADs) involve the descending aorta and can present with complications, including malperfusion syndrome or aortic rupture, which are associated with significant morbidity and mortality if left untreated. Clinical diagnosis is straightforward, typically confirmed using CT angiography. Treatment begins with immediate anti-impulse medical therapy. Acute TBAD with complications should be repaired with emergent thoracic endovascular aortic repair (TEVAR). Uncomplicated TBAD with high-risk features should undergo TEVAR in the subacute phase. Open surgical repair is seldom required and reserved only for select cases. It is critical to follow these patients clinically and radiographically in the outpatient setting.
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Affiliation(s)
- Daniel B Alfson
- Division of Vascular Surgery, Department of Surgery, Keck School of Medicine of USC, University of Southern California, 1520 San Pablo Street, HCC II, Suite 4300, Los Angeles, CA 90033-5330, USA
| | - Sung W Ham
- Division of Vascular Surgery, Department of Surgery, Keck School of Medicine of USC, University of Southern California, 1520 San Pablo Street, HCC II, Suite 4300, Los Angeles, CA 90033-5330, USA.
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573
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Payabyab EC, Maloney AH, Brinster DR. Undersized Stent Grafts for Acute Mesenteric Ischemia in Chronic Type B Dissection. Ann Thorac Surg 2017; 103:e501-e503. [PMID: 28528051 DOI: 10.1016/j.athoracsur.2016.12.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2016] [Accepted: 12/10/2016] [Indexed: 10/19/2022]
Abstract
Acute ischemia in chronic type B dissections carries high rates of morbidity and mortality. A 29-year-old woman with a chronic type B dissection presented with acute abdominal pain. Imaging revealed a worsening dissection with pseudocoarctation causing near complete occlusion of the true lumen by the false lumen. We placed purposefully undersized stent grafts to treat acute mesenteric ischemia by improving true lumen flow. The patient was discharged on postoperative day 4 without adverse events. We suggest that endovascular rescue by placing undersized stent grafts can provide improved flow to the mesenteric vessels with continued false lumen flow to vital organs.
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Affiliation(s)
- Eden C Payabyab
- Virginia Commonwealth University Health Systems, Richmond, Virginia.
| | - Andrew H Maloney
- Virginia Commonwealth University Health Systems, Richmond, Virginia
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574
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Sailer AM, Nelemans PJ, Hastie TJ, Chin AS, Huininga M, Chiu P, Fischbein MP, Dake MD, Miller DC, Schurink GW, Fleischmann D. Prognostic significance of early aortic remodeling in acute uncomplicated type B aortic dissection and intramural hematoma. J Thorac Cardiovasc Surg 2017; 154:1192-1200. [PMID: 28668458 DOI: 10.1016/j.jtcvs.2017.04.064] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2016] [Revised: 03/02/2017] [Accepted: 04/03/2017] [Indexed: 01/16/2023]
Abstract
BACKGROUND Patients with Stanford type B aortic dissections (ADs) are at risk of long-term disease progression and late complications. The aim of this study was to evaluate the natural course and evolution of acute type B AD and intramural hematomas (IMHs) in patients who presented without complications during their initial hospital admission and who were treated with optimal medical management (MM). METHODS Databases from 2 aortic centers in Europe and the United States were used to identify 136 patients with acute type B AD (n = 92) and acute type B IMH (n = 44) who presented without complications during their index admission and were treated with MM. Computed tomography angiography scans were available at onset (≤14 days) and during follow-up for those patients. Relevant data, including evidence of adverse events during follow-up (AE; defined according to current guidelines), were retrieved from medical records and by reviewing computed tomography scan images. Aortic diameters were measured with dedicated 3-dimensional software. RESULTS The 1-, 2-, and 5-year event-free survival rates of patients with type B AD were 84.3% (95% confidence interval [CI], 74.4-90.6), 75.4% (95% CI, 64.0-83.7), and 62.6% (95% CI, 68.9-73.6), respectively. Corresponding estimates for IMH were 76.5% (95% CI, 57.8-87.8), 76.5% (95% CI, 57.8-87.8), and 68.9% (95% CI, 45.2-83.9), respectively. In patients with type B AD, risk of an AE increased with aortic growth within the first 6 months after onset. A diameter increase of 5 mm in the first half year was associated with a relative risk for AE of 2.29 (95% CI, 1.70-3.09) compared with the median 6 months' growth of 2.4 mm. In approximately 60% of patients with IMH, the abnormality resolved within 12 months and in the patients with nonresolving IMH, risk of an adverse event was greatest in the first year after onset and remained stable thereafter. CONCLUSIONS More than one third of patients with initially uncomplicated type B AD suffer an AE under MM within 5 years of initial diagnosis. In patients with nonresolving IMH, most adverse events are observed in the first year after onset. In patients with type B AD an early aortic growth is associated with a greater risk of AE.
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Affiliation(s)
- Anna M Sailer
- Department of Radiology, Stanford University School of Medicine, Stanford, Calif; Department of Radiology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Patricia J Nelemans
- Department of Epidemiology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Trevor J Hastie
- Department of Biomedical Data Sciences, Stanford University School of Medicine, Stanford, Calif; Department of Statistics, Stanford University, Stanford, Calif
| | - Anne S Chin
- Department of Radiology, Stanford University School of Medicine, Stanford, Calif
| | - Mark Huininga
- Department of Vascular Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Peter Chiu
- Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, Calif
| | - Michael P Fischbein
- Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, Calif
| | - Michael D Dake
- Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, Calif; Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, Calif
| | - D Craig Miller
- Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, Calif
| | - G W Schurink
- Department of Vascular Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Dominik Fleischmann
- Department of Radiology, Stanford University School of Medicine, Stanford, Calif; Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, Calif.
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575
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Sultan S, Kavanagh EP, Stefanov F, Sultan M, Elhelali A, Costache V, Diethrich E, Hynes N. Endovascular management of chronic symptomatic aortic dissection with the Streamliner Multilayer Flow Modulator: Twelve-month outcomes from the global registry. J Vasc Surg 2017; 65:940-950. [PMID: 28342521 DOI: 10.1016/j.jvs.2016.09.059] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Accepted: 09/04/2016] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Reported are initial 12-month outcomes of patients with chronic symptomatic aortic dissection managed by the Streamliner Multilayer Flow Modulator (SMFM; Cardiatis, Isnes, Belgium). Primary end points were freedom from rupture- and aortic-related death, and reduction in false lumen index. Secondary end points were patency of great vessels and visceral branches, and freedom of stroke, paraplegia, and renal failure. METHODS Out of 876 SMFM implanted globally, we have knowledge of 542. To date, 312 patients are maintained in the global registry, of which 38 patients were identified as having an aortic dissection (12.2%). Indications included 35 Stanford type B dissections, two Stanford type A and B dissections, and one mycotic Stanford type B dissection. RESULTS There were no reported ruptures or aortic-related deaths. All cause survival was 85.3% Twelve-month freedom from neurologic events was 100%, and there were no incidences of end-organ ischemia, paraplegia or renal insult. Morphologic analysis exhibited dissection remodeling by a reduction in longitudinal length of the dissected aorta, and false lumen volume. A statistically significant reduction in false lumen index (P = .016) at 12 months, and a borderline significant increase in true lumen volume (P = .053) confirmed dissection remodeling. CONCLUSIONS The SMFM is an option in management of complex pan-aortic dissection. Results highlight SMFM implantation leads to dissection stabilization with no further aneurysm progression, and no retrograde type A dissection. Thoracic endovascular aneurysm repair by SMFM ensued in freedom from aortic rupture, neurologic stroke, paraplegia and renal failure. Further analysis of the global registry data will inform long-term outcomes.
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Affiliation(s)
- Sherif Sultan
- Department of Vascular and Endovascular Surgery, Western Vascular Institute, Galway University Hospital, National University of Ireland, Galway, Ireland; Department of Vascular and Endovascular Surgery, Galway Clinic, Doughiska, Galway, Ireland.
| | - Edel P Kavanagh
- Department of Vascular and Endovascular Surgery, Galway Clinic, Doughiska, Galway, Ireland
| | - Florian Stefanov
- Department of Mechanical and Industrial Engineering, Galway Medical Technologies Center (GMedTech), Galway Mayo Institute of Technology, Galway, Ireland
| | - Mohamed Sultan
- Department of Vascular and Endovascular Surgery, Western Vascular Institute, Galway University Hospital, National University of Ireland, Galway, Ireland
| | - Ala Elhelali
- Department of Vascular and Endovascular Surgery, Western Vascular Institute, Galway University Hospital, National University of Ireland, Galway, Ireland; Department of Mechanical and Industrial Engineering, Galway Medical Technologies Center (GMedTech), Galway Mayo Institute of Technology, Galway, Ireland
| | - Victor Costache
- Department of Cardio-Vascular Surgery, European Clinic Polisano Hospital, Sibiu, Romania
| | | | - Niamh Hynes
- Department of Vascular and Endovascular Surgery, Western Vascular Institute, Galway University Hospital, National University of Ireland, Galway, Ireland; Department of Vascular and Endovascular Surgery, Galway Clinic, Doughiska, Galway, Ireland
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576
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Innovative postmarket device evaluation using a quality registry to monitor thoracic endovascular aortic repair in the treatment of aortic dissection. J Vasc Surg 2017; 65:1280-1286. [DOI: 10.1016/j.jvs.2016.11.054] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2016] [Accepted: 11/19/2016] [Indexed: 11/24/2022]
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577
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Yang KQ, Yang YK, Meng X, Zhang Y, Zhang HM, Wu HY, Liu YX, Jiang XJ, Cai J, Zhou XL, Hui RT, Zheng DY, Liu LS. Aortic Dissection in Takayasu Arteritis. Am J Med Sci 2017; 353:342-352. [DOI: 10.1016/j.amjms.2017.01.010] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Revised: 01/14/2017] [Accepted: 01/19/2017] [Indexed: 11/27/2022]
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578
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Kamman AV, Brunkwall J, Verhoeven EL, Heijmen RH, Trimarchi S, Kasprzak P, Brunkwall J, Heijmen R, Alric P, Verhoeven E, Schumacher H, Fabiani JN, Eckstein HH, Taylor P, Mailina M, Mangialardi N, Larzon T, Böckler D, Lönn L, Dialetto G, Trimarchi S, Lammer J. Predictors of aortic growth in uncomplicated type B aortic dissection from the Acute Dissection Stent Grafting or Best Medical Treatment (ADSORB) database. J Vasc Surg 2017; 65:964-971.e3. [DOI: 10.1016/j.jvs.2016.09.033] [Citation(s) in RCA: 79] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2016] [Accepted: 09/01/2016] [Indexed: 01/16/2023]
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579
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Matt P, Banerjee P, Grapow M, Rueter F, Schurr U, Siegemund M, Fassl J, Reuthebuch O, Eckstein F. Modified frozen elephant trunk for acute type A aortic dissection: a comparative study with standard repair technique. Eur J Cardiothorac Surg 2017; 51:754-760. [PMID: 28062548 DOI: 10.1093/ejcts/ezw412] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2016] [Accepted: 11/23/2016] [Indexed: 01/16/2023] Open
Abstract
Objectives We hypothesized that antegrade open stent graft implantation in the descending aorta during acute type A aortic dissection surgery is safe and improves patient outcome compared with the standard repair technique. Methods Hundred and forty-one consecutive patients underwent surgery for acute type A aortic dissection at our institution from 2010 to 2016. Of those, 104 patients underwent ascending aorta and hemiarch repair under hypothermic circulatory arrest with antegrade cerebral perfusion (standard group). Since 2013, 37 patients have undergone the standard procedure combined with antegrade stent implantation in the descending aorta (stented group). A matched analysis using the logistic EuroSCORE (37 patients per group) was done. All data were collected prospectively. Results The mean logistic EuroSCORE was 29 in both groups, P = 1. Cardiopulmonary bypass time was 150 ± 57 (standard) vs 157 ± 48 (stented) min, P = 0.6; aortic clamping 99 ± 47 (standard) vs 100 ± 36 (stented) min, P = 1. Stented patients had longer circulatory arrest times with antegrade cerebral perfusion, 23 ± 7 vs 15 ± 7 min, P < 0.001. Stroke occurred in 24.3% (standard) vs 8.1% (stented), P = 0.1; paraplegia developed in 2.7% (standard) vs 0% (stented), P = 1. Abdominal intervention due to suspected visceral ischaemia was needed in 18.9% (standard) vs 5.4% (stented), P = 0.2. 30-day mortality was 13.5% (standard) vs 0% (stented), P = 0.05. Survival at 6-month was 100% and 86.5% in patients with implanted stents and standard repair, respectively, P = 0.02. Conclusions Antegrade, open stent graft implantation into the descending aorta during acute type A aortic dissection repair is safe and is associated with improved outcomes at 6 months postoperatively compared to the standard repair technique.
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Affiliation(s)
- Peter Matt
- Division of Cardiac Surgery, University Hospital Basel, Basel, Switzerland
| | - Prerana Banerjee
- Division of Cardiac Surgery, University Hospital Basel, Basel, Switzerland
| | - Martin Grapow
- Division of Cardiac Surgery, University Hospital Basel, Basel, Switzerland
| | - Florian Rueter
- Division of Cardiac Surgery, University Hospital Basel, Basel, Switzerland
| | - Ulrich Schurr
- Division of Cardiac Surgery, University Hospital Basel, Basel, Switzerland
| | - Martin Siegemund
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Basel, Basel, Switzerland
| | - Jens Fassl
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Basel, Basel, Switzerland
| | - Oliver Reuthebuch
- Division of Cardiac Surgery, University Hospital Basel, Basel, Switzerland
| | - Friedrich Eckstein
- Division of Cardiac Surgery, University Hospital Basel, Basel, Switzerland
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580
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Waweru P, Gill H, Abeid C. Protracted refractory pain post-TEVAR: post-implantation syndrome? J Surg Case Rep 2017; 2016:rjw173. [PMID: 28344762 PMCID: PMC5155580 DOI: 10.1093/jscr/rjw173] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Accepted: 10/04/2016] [Indexed: 11/14/2022] Open
Abstract
Aortic dissection is a life-threatening condition and has one of the highest mortality rates of cardiovascular diseases. It remains a devastating disease; with multiple unanswered questions concerning treatment modalities. The role of thoracic endovascular aortic repair (TEVAR) in these patients; especially those with uncomplicated acute aortic Type B dissections (AAD-B) is especially controversial although it has been shown to have better long-term outcomes compared to medical therapy alone. For those who have TEVAR, up to 60% may develop an acute, transient systemic inflammatory response syndrome that remains vaguely defined. The role of local inflammation in this post-implantation syndrome (PIS) has not been highlighted. We present a case of a 57-year-old male patient with an uncomplicated AAD-B who developed an ‘atypical’ PIS post-TEVAR with severe refractory abdominal pains; leukocytosis and raised C-reactive protein. The role of local inflammation in PIS is highlighted.
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Affiliation(s)
- Peter Waweru
- Department of Surgery , MP Shah Hospital , Nairobi, Nairobi-Kenya
| | - Hardeep Gill
- Department of Vascular Surgery , MP Shah Hospital, PO Box 14497-00800, Nairobi , Nairobi-Kenya
| | - Chris Abeid
- Department of Internal Medicine/Nephrology , MP Shah Hospital, PO Box 14497-00800, Nairobi , Nairobi-Kenya
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581
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Abstract
OPINION STATEMENT Advances in medical therapy and non-surgical percutaneous options to manage the specter of acute aortic syndromes have improved both patient morbidity and mortality. There are key features in the patient history and initial exam which physicians should be attuned to in order to diagnose acute aortic syndromes such as aortic dissection, penetrating aortic ulcer, and intramural hematoma. Once recognized, early initiation of the appropriate pharmacologic therapy is important, and further appreciating the limitations of such therapy before considering a surgical approach is critical to improve patient outcomes. For the undifferentiated patient with acute aortic dissection presenting to facilities who do not routinely manage this condition, adding pharmacologic agents in the correct sequence assures the best chance for a satisfactory outcome.
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582
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Wang T, Shu C, Li M, Li QM, Li X, Qiu J, Fang K, Dardik A, Yang CZ. Thoracic Endovascular Aortic Repair With Single/Double Chimney Technique for Aortic Arch Pathologies. J Endovasc Ther 2017; 24:383-393. [PMID: 28387611 DOI: 10.1177/1526602817698702] [Citation(s) in RCA: 62] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Purpose: To summarize a single-center experience using the single/double chimney technique in association with thoracic endovascular aortic repairs (TEVAR) for aortic arch pathologies. Methods: From November 2007 to March 2016, 122 patients (mean age 50.4±12.7 years, range 29–80; 92 men) with aortic arch pathologies underwent TEVAR combined with single (n=101) or double (n=21) chimney grafts to reconstruct the supra-aortic branches: 21 innominate arteries, 114 left common carotid arteries, and 8 left subclavian arteries (LSA). Pathologies included type B aortic dissection (n=47), aortic arch dissection (n=49), retrograde type A aortic dissection (n=8), thoracic aortic aneurysm (n=7), penetrating aortic arch ulcer (n=9), and post-TEVAR type I endoleak (n=2). Follow-up examinations included computed tomography at 0.5, 3, 6, and 12 months and yearly thereafter. Results: The aortic stent-grafts were deployed in zone 0 (n=21), zone 1 (n=93), and zone 2 (n=8). One (0.8%) of the 122 patients died at 4 days due to a perforated peptic ulcer. Type Ia endoleaks were found intraoperatively in 13 (10.7%) patients, including 3 with the double chimney technique. Type II endoleaks occurred in 6 (4.9%) patients; 3 were treated with duct occluders in the LSA. Postoperative chimney graft migration occurred in 1 (0.8%) patient with double chimneys; additional stent-grafts were deployed in both chimneys. Median follow-up was 32.3 months, during which 1 (0.8%) patient died after a stroke at 3 months. Chimney stent-graft patency was observed in the remaining 120 patients. Two (1.7%) secondary TEVARs were performed for distal aortic dissection. Nine asymptomatic type Ia endoleaks and 1 type II endoleak persisted in follow-up; a type II endoleak in 1 patient with Marfan syndrome sealed in 52 months. Conclusion: TEVAR with the chimney technique provides a safe, minimally invasive alternative with good chimney graft patency and low postoperative mortality during midterm follow-up. The double chimney technique should be used judiciously owing to its potential complications.
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Affiliation(s)
- Tun Wang
- Department of Vascular Surgery, The 2nd Xiang-ya Hospital, Changsha, Hunan, China
- Angiopathy Institute, Central South University, Changsha, Hunan, China
| | - Chang Shu
- Department of Vascular Surgery, The 2nd Xiang-ya Hospital, Changsha, Hunan, China
- Angiopathy Institute, Central South University, Changsha, Hunan, China
- Department of Cardiovascular Surgery, Chinese Academy of Medical Sciences and Peking Union Medical College Fuwai Hospital, Xicheng District, Beijing, China
| | - Ming Li
- Department of Vascular Surgery, The 2nd Xiang-ya Hospital, Changsha, Hunan, China
- Angiopathy Institute, Central South University, Changsha, Hunan, China
| | - Quan-ming Li
- Department of Vascular Surgery, The 2nd Xiang-ya Hospital, Changsha, Hunan, China
- Angiopathy Institute, Central South University, Changsha, Hunan, China
| | - Xin Li
- Department of Vascular Surgery, The 2nd Xiang-ya Hospital, Changsha, Hunan, China
- Angiopathy Institute, Central South University, Changsha, Hunan, China
| | - Jian Qiu
- Department of Vascular Surgery, The 2nd Xiang-ya Hospital, Changsha, Hunan, China
- Angiopathy Institute, Central South University, Changsha, Hunan, China
| | - Kun Fang
- Department of Cardiovascular Surgery, Chinese Academy of Medical Sciences and Peking Union Medical College Fuwai Hospital, Xicheng District, Beijing, China
| | - Alan Dardik
- Department of Surgery, Yale University School of Medicine, New Haven, CT, USA
| | - Chen-zi Yang
- Department of Vascular Surgery, The 2nd Xiang-ya Hospital, Changsha, Hunan, China
- Angiopathy Institute, Central South University, Changsha, Hunan, China
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583
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Hsu HL, Shih CC. Re-intervention after thoracic endovascular aortic repair is high, but we should keep optimistic. J Thorac Dis 2017; 9:E162-E163. [PMID: 28275505 DOI: 10.21037/jtd.2017.02.12] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Affiliation(s)
- Hung-Lung Hsu
- School of Medicine, National Yang-Ming University, Taipei, Taiwan; ; Department of Cardiovascular Surgery, Far Eastern Memorial Hospital, New Taipei City, Taiwan; ; Division of Cardiovascular Surgery, Department of Surgery, Mennonite Christian Hospital, Hualien, Taiwan
| | - Chun-Che Shih
- School of Medicine, National Yang-Ming University, Taipei, Taiwan; ; Division of Cardiovascular Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan; ; Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan
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584
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Kilic A, Siki MA, Szeto WY, Bavaria JE, Anwaruddin S, Desai ND. Concomitant Endografting of a Type B Aortic Dissection During Transfemoral Aortic Valve Replacement. Ann Thorac Surg 2017; 103:e223-e224. [DOI: 10.1016/j.athoracsur.2016.08.070] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Revised: 07/15/2016] [Accepted: 08/19/2016] [Indexed: 11/29/2022]
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585
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Preoperative thoracic false lumen branches relate to aortic remodeling after thoracic endovascular aortic repair for DeBakey IIIb aortic dissection. J Vasc Surg 2017; 65:659-668.e2. [DOI: 10.1016/j.jvs.2016.09.023] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2016] [Accepted: 09/01/2016] [Indexed: 11/20/2022]
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586
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Abugov SA, Polyakov RS, Pyreckiy MV, Saakyan YM. [Decision making algorithm in distal thoracic aortic dissections]. Khirurgiia (Mosk) 2017:4-10. [PMID: 27804928 DOI: 10.17116/hirurgia2016104-10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- S A Abugov
- Petrovsky Russian Research Center of Surgery; Russian Medical Academy of Postgraduate Education, Health Ministry of the Russian Federation, Moscow, Russia
| | - R S Polyakov
- Petrovsky Russian Research Center of Surgery; Russian Medical Academy of Postgraduate Education, Health Ministry of the Russian Federation, Moscow, Russia
| | - M V Pyreckiy
- Petrovsky Russian Research Center of Surgery; Russian Medical Academy of Postgraduate Education, Health Ministry of the Russian Federation, Moscow, Russia
| | - Yu M Saakyan
- Petrovsky Russian Research Center of Surgery; Russian Medical Academy of Postgraduate Education, Health Ministry of the Russian Federation, Moscow, Russia
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587
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Repair of Chronic Aneurysmal Aortic Dissection Using a Stent Graft and an Amplatzer® Vascular Plug: A Case Study. Ann Vasc Surg 2017; 39:288.e5-288.e12. [DOI: 10.1016/j.avsg.2016.06.032] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Revised: 06/03/2016] [Accepted: 06/24/2016] [Indexed: 11/18/2022]
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588
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Chen IM, Chen PL, Huang CY, Weng SH, Chen WY, Shih CC. Factors Affecting Optimal Aortic Remodeling After Thoracic Endovascular Aortic Repair of Type B (IIIb) Aortic Dissection. Cardiovasc Intervent Radiol 2017; 40:671-681. [DOI: 10.1007/s00270-017-1563-y] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Accepted: 12/31/2016] [Indexed: 11/28/2022]
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589
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Cerna M, Kocher M, Thomas RP. Acute aorta, overview of acute CT findings and endovascular treatment options. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2017; 161:14-23. [PMID: 28115748 DOI: 10.5507/bp.2016.060] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Accepted: 11/28/2016] [Indexed: 01/17/2023] Open
Abstract
Acute aortic pathologies include acute aortic syndrome (aortic dissection, intramural hematoma, penetrating aortic ulcer), impending rupture, aortic aneurysm rupture and aortic trauma. Acute aortic syndrome, aortic aneurysm rupture and aortic trauma are life-threatening conditions requiring prompt diagnosis and treatment. The basic imaging modality for "acute aorta" is CT angiography with typical findings for these aortic pathologies. Based on the CT, it is possible to classify aortic diseases and anatomical classifications are essential for the planning of treatment. Currently, endovascular treatment is the method of choice for acute diseases of the descending thoracic aorta and is increasingly indicated for patients with ruptured abdominal aortic aneurysms.
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Affiliation(s)
- Marie Cerna
- Department of Radiology, University Hospital Olomouc and Faculty of Medicine and Dentistry, Palacky University Olomouc, Czech Republic.,Department of Technical Disciplines in Health Care, Faculty of Health Care, University of Presov, Slovak Republic
| | - Martin Kocher
- Department of Radiology, University Hospital Olomouc and Faculty of Medicine and Dentistry, Palacky University Olomouc, Czech Republic
| | - Rohit Philip Thomas
- Institute of Diagnostic and Interventional Radiology, Klinikum Oldenburg, Oldenburg, Germany
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590
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Fujimura N, Kawaguchi S, Obara H, Yoshitake A, Inoue M, Otsubo S, Kitagawa Y, Shimizu H. Anatomic Feasibility of Next-Generation Stent Grafts for the Management of Type A Aortic Dissection in Japanese Patients. Circ J 2017; 81:1388-1394. [DOI: 10.1253/circj.cj-17-0100] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Naoki Fujimura
- Department of Vascular Surgery, Saiseikai Central Hospital
- Department of Cardiovascular Surgery, Saiseikai Central Hospital
- Department of Surgery, Keio University School of Medicine
| | - Shinji Kawaguchi
- Department of Cadiovascular Surgery, Keio University School of Medicine
| | - Hideaki Obara
- Department of Surgery, Keio University School of Medicine
| | - Akihiro Yoshitake
- Department of Cadiovascular Surgery, Keio University School of Medicine
| | - Masanori Inoue
- Department of Radiology, Keio University School of Medicine
| | - Satoshi Otsubo
- Department of Cardiovascular Surgery, Saiseikai Central Hospital
| | - Yuko Kitagawa
- Department of Surgery, Keio University School of Medicine
| | - Hideyuki Shimizu
- Department of Cadiovascular Surgery, Keio University School of Medicine
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591
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Abstract
Traditionally, the surgical management of acute type B aortic dissections was reserved for patients with signs of malperfusion, rapid expansion, retrograde dissection or rupture. The adjunct of endovascular techniques has brought a paradigm shift, leaning towards preventing long term dissection complications. Multiple risk factors have been proposed to identify patients at risk for long term aortic complications. The patients, who are offered a prophylactic endovascular therapy for uncomplicated aortic dissection, should be selected carefully, and offered intervention by an experienced team in a high-volume center. (This is a review article based on the invited lecture of the 57th Annual Meeting of Japanese College of Angiology.).
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Affiliation(s)
- Emilia Krol
- Division of Vascular Surgery, Eastern Virginia Medical School, Norfolk, Virginia, USA
| | - Jean M Panneton
- Division of Vascular Surgery, Eastern Virginia Medical School, Norfolk, Virginia, USA
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592
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593
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Khoynezhad A, Toluie S, Al-Atassi T. Treatment of the Chronic Type B Aortic Dissection: The Pro-endovascular Argument. Semin Thorac Cardiovasc Surg 2017; 29:131-136. [DOI: 10.1053/j.semtcvs.2017.03.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/15/2017] [Indexed: 11/11/2022]
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594
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Schermerhorn M, Jones D. Management of Descending Thoracic Aorta Disease: Evolving Treatment Paradigms in the TEVAR Era. Eur J Vasc Endovasc Surg 2017; 53:1-3. [DOI: 10.1016/j.ejvs.2016.06.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Accepted: 06/21/2016] [Indexed: 01/16/2023]
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595
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Mizoguchi T, Zempo N, Kaneda Y. Early and Mid-Term Outcomes Following TEVAR for Chronic Type B Aortic Dissection. Ann Vasc Dis 2017. [PMID: 29515694 PMCID: PMC5835438 DOI: 10.3400/avd.oa.17-00078] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
We examined the outcomes of aortic remodeling for chronic type B aortic dissection (cTBD) after thoracic endovascular aneurysm repair (TEVAR). Objective & Methods: Thirty-eight patients underwent TEVAR for cTBD at our institution. We classified cTBD patients into the early cTBD group (16 cases, 2 weeks–4 months from onset) and late cTBD group (22 cases, >4 months from onset). Results: There were no cases of paraplegia, stroke, and hospital death in both groups. There was no worsening of complicated cases. We achieved false lumen thrombosis in cases with a double-barreled thoracic aorta. The early cTBD group had more complete shrinkage cases (60%) than the late cTBD group (11%). Conclusion: We obtained favorable mid-term outcomes after TEVAR for cTBD patients. Early cTBD patients obtained good aortic remodeling with TEVAR. (This is a translation of Jpn J Vasc Surg 2016; 25: 233–239.)
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Affiliation(s)
- Takahiro Mizoguchi
- Department of Surgery, Yamaguchi Prefecture Grand Medical Center, Hofu, Yamaguchi, Japan
| | - Nobuya Zempo
- Department of Surgery, Yamaguchi Prefecture Grand Medical Center, Hofu, Yamaguchi, Japan
| | - Yoshikazu Kaneda
- Department of Surgery, Yamaguchi Prefecture Grand Medical Center, Hofu, Yamaguchi, Japan
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596
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Riambau V, Böckler D, Brunkwall J, Cao P, Chiesa R, Coppi G, Czerny M, Fraedrich G, Haulon S, Jacobs M, Lachat M, Moll F, Setacci C, Taylor P, Thompson M, Trimarchi S, Verhagen H, Verhoeven E, ESVS Guidelines Committee, Kolh P, de Borst G, Chakfé N, Debus E, Hinchliffe R, Kakkos S, Koncar I, Lindholt J, Vega de Ceniga M, Vermassen F, Verzini F, Document Reviewers, Kolh P, Black J, Busund R, Björck M, Dake M, Dick F, Eggebrecht H, Evangelista A, Grabenwöger M, Milner R, Naylor A, Ricco JB, Rousseau H, Schmidli J. Editor's Choice – Management of Descending Thoracic Aorta Diseases. Eur J Vasc Endovasc Surg 2017; 53:4-52. [DOI: 10.1016/j.ejvs.2016.06.005] [Citation(s) in RCA: 598] [Impact Index Per Article: 85.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
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597
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Treatment of uncomplicated type B aortic dissection. Gen Thorac Cardiovasc Surg 2016; 65:74-79. [DOI: 10.1007/s11748-016-0734-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Accepted: 11/25/2016] [Indexed: 10/20/2022]
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598
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Guo Y, Cai H, Yang B, Jin H. Simultaneous Endovascular Repair for Thoracic and Abdominal Aortic Pathologies: Early and Midterm Results. Ann Vasc Surg 2016; 40:178-182. [PMID: 27903477 DOI: 10.1016/j.avsg.2016.08.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2016] [Revised: 07/07/2016] [Accepted: 08/04/2016] [Indexed: 11/19/2022]
Abstract
BACKGROUND To analyze information from a single clinical center, evaluating early and midterm results of simultaneous thoracic endovascular aortic repair (TEVAR) and endovascular aneurysm repair (EVAR) for coexisting thoracic and abdominal aortic pathologies. METHODS From January 2005 to December 2014, 13 patients (8 men, 5 women; mean age, 75.3 years; range, 69-82 years) with concomitant thoracic and abdominal aortic disease (aneurysms, type B dissection, penetrating aortic ulcers) were treated with simultaneous TEVAR and EVAR. All patients had significant comorbidities. No preoperative cerebrospinal fluid drainage was performed. The follow-up rate was 100% during a period of 36 months (range, 1-60 months). RESULTS Technical success was achieved in all 13 patients, including deliberate partial or total coverage of the left subclavian artery in 3 patients, coverage of both internal iliac arteries in 1 patient, and coverage of left subclavian artery and unilateral internal iliac artery in 1 patient. The average procedural time was 160 min (range, 120-200 min). Mean blood loss was 140 mL (range, 100-250 mL). Four types of commercially available stent grafts (SGs) were used. The lengths of the thoracic SGs were 150-200 cm. Overall survival was 92.3% at 1- and 3-year follow-ups. None of the patients developed stroke or paralysis. The average hospital stay was 9 days (range, 7-12 days). No patients developed endoleak or SG migration. CONCLUSIONS Combined TEVAR and EVAR can be performed successfully with minimal morbidity and mortality. When anatomically feasible, simultaneous TEVAR and EVAR is a viable alternative to staged or hybrid repair.
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Affiliation(s)
- Yuanyuan Guo
- Department of Vascular Surgery, The First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, PR China
| | - Hongbo Cai
- Department of Vascular Surgery, The First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, PR China
| | - Bin Yang
- Department of Vascular Surgery, The First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, PR China
| | - Hui Jin
- Department of Vascular Surgery, The First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, PR China.
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599
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Aguir S, El Batti S, Achouh P, Julia P, Bel A, Fabiani JN, Alsac JM. Technical Aspects of Open Repair for Degenerative Aneurysmal Evolution Despite Early Thoracic Endovascular Repair of Type B Aortic Dissection. Ann Vasc Surg 2016; 40:297.e13-297.e17. [PMID: 27903475 DOI: 10.1016/j.avsg.2016.08.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Revised: 08/01/2016] [Accepted: 08/02/2016] [Indexed: 11/24/2022]
Abstract
BACKGROUND Closure of the proximal tear by thoracic endovascular aortic repair (TEVAR) at the acute phase appears to be a safe effective treatment to prevent aneurysmal degeneration type B dissection. However, it appears to be inefficient in up to a third of the patient. We report the technical aspects of our experience with patients undergoing secondary open repair after TEVAR for dissecting thoracoabdominal aneurysm despite early closure proximal tear by TEVAR. METHODS During a period of 5 years, 96 patients presenting acute type B aortic dissections were treated by TEVAR and followed-up in our institution. Among them, 5 patients experienced an evolution to a dissecting thoracoabdominal aortic aneurysm. Their demographic data and initial medical conditions, delay to reintervention, operative technical details, perioperative and mid-term outcomes were collected and analyzed. RESULTS All 5 patients (4 male, mean age 58 ± 9) were operated under peripheral normothermic bypass without deep circulatory arrest using the thoracic stent graft as an elephant trunk for completion of the proximal anastomosis. In cases of patency, the false lumen was reapproximated in the anastomosis, 6 visceral arteries were revascularized selectively. One patient died at day 1 of perioperative ventricular fibrillation due to an acute myocardial infarction. The 4 others are alive without complication after a median of 30 months, range (13-22). CONCLUSIONS In our experience, TEVAR was not only efficient at the acute phase to deal with complications, but in cases of subsequent aneurysmal evolution, it made open repair even easier by avoiding very proximal cross-clamping/anastomosis and circulatory arrest.
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Affiliation(s)
- Sonia Aguir
- Department of Cardiovascular Surgery, Assistance Publique, Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Paris, France
| | - Salma El Batti
- Department of Cardiovascular Surgery, Assistance Publique, Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Paris, France; INSERM U970, PARCC, University Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - Paul Achouh
- Department of Cardiovascular Surgery, Assistance Publique, Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Paris, France; INSERM U970, PARCC, University Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - Pierre Julia
- Department of Cardiovascular Surgery, Assistance Publique, Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Paris, France; INSERM U970, PARCC, University Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - Alain Bel
- Department of Cardiovascular Surgery, Assistance Publique, Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Paris, France
| | - Jean-Noël Fabiani
- Department of Cardiovascular Surgery, Assistance Publique, Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Paris, France; INSERM U970, PARCC, University Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - Jean-Marc Alsac
- Department of Cardiovascular Surgery, Assistance Publique, Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Paris, France; INSERM U970, PARCC, University Paris Descartes, Sorbonne Paris Cité, Paris, France.
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600
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Owen JW, Raptis CA. Emerging Clinical Applications of 4D Flow MR in the Heart and Aorta. CURRENT RADIOLOGY REPORTS 2016. [DOI: 10.1007/s40134-016-0188-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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