51
|
Nienaber CA, Clough RE. Management of Acute Aortic Syndromes. Interv Cardiol 2016. [DOI: 10.1002/9781118983652.ch71] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
|
52
|
Prognostic Significance of Sleep Apnea Syndrome on False Lumen Aortic Expansion in Post-Acute Aortic Syndrome. Ann Thorac Surg 2016; 102:1558-1564. [DOI: 10.1016/j.athoracsur.2016.03.102] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2015] [Revised: 03/24/2016] [Accepted: 03/28/2016] [Indexed: 12/25/2022]
|
53
|
Feasibility of a proposed randomized trial in patients with uncomplicated descending thoracic aortic dissection: Results of worldwide survey. Am Heart J 2016; 181:137-144. [PMID: 27823685 DOI: 10.1016/j.ahj.2016.07.019] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2016] [Accepted: 07/26/2016] [Indexed: 11/22/2022]
Abstract
The trial we propose will be the first multicenter, randomized, trial investigating the role of thoracic endovascular aortic repair (TEVAR) of uncomplicated type B aortic dissection (TBAD) compared to conservative (medical) management. To document the current management approaches for uncomplicated TBAD, we performed an international survey in 130 centers (in US and worldwide), of whom 114 (89%) responded. Sixty-three (54.8%) respondents do not routinely stent uncomplicated TBAD, and 43 (37.4%) perform TEVAR based on various imaging criteria. One hundred and one respondents (88.6%) agreed that equipoise was present. Almost all respondents agreed that demonstrating an improvement in major aortic complication-free survival with TBAD would lead to change in practice. The results of the survey demonstrate that a major randomized trial to determine the optimal management strategy for uncomplicated TBAD is warranted.
Collapse
|
54
|
Yamada Y, Tanno J, Nakano S, Kasai T, Senbonmatsu T, Nishimura S. Clinical implications of pleural effusion in patients with acute type B aortic dissection. EUROPEAN HEART JOURNAL-ACUTE CARDIOVASCULAR CARE 2016; 5:72-81. [DOI: 10.1177/2048872615594498] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Yoshihiro Yamada
- The Department of Cardiology, International Medical Center, Saitama Medical University, Japan
| | - Jun Tanno
- The Department of Cardiology, International Medical Center, Saitama Medical University, Japan
| | - Shintaro Nakano
- The Department of Cardiology, International Medical Center, Saitama Medical University, Japan
| | - Takatoshi Kasai
- The Department of Cardiovascular Medicine and Cardiovascular Respiratory Sleep Medicine, Juntendo University Graduate School of Medicine, Japan
| | - Takaaki Senbonmatsu
- The Department of Cardiology, International Medical Center, Saitama Medical University, Japan
| | - Shigeyuki Nishimura
- The Department of Cardiology, International Medical Center, Saitama Medical University, Japan
| |
Collapse
|
55
|
Kamman AV, van Herwaarden JA, Orrico M, Nauta FJH, Heijmen RH, Moll FL, Trimarchi S. Standardized Protocol to Analyze Computed Tomography Imaging of Type B Aortic Dissections. J Endovasc Ther 2016; 23:472-82. [DOI: 10.1177/1526602816642591] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Purpose: To propose a standard measuring protocol for type B aortic dissections so as to improve comparability between studies reporting aortic dimensions. Methods: Fifteen computed tomography (CT) scans of type B aortic dissections were measured with a standard protocol by 2 independent observers using postprocessing software. The following parameters were assessed: true, false, and total lumen diameter; true and false lumen volume; and entry tear size, location, and number. Diameters were measured in a perpendicular plane at 2, 10, and 20 cm from the left subclavian artery and 5 cm from the most distal renal artery. True lumen volume was assessed from the left subclavian artery to the aortic bifurcation, while the false lumen volume was from the start to end up to the aortic bifurcation. Entry tear location was assessed in relation to the left subclavian artery. Intra- and interobserver repeatability and agreement were evaluated using the Bland-Altman method, an a priori set of acceptable differences, and Lin’s concordance correlation coefficient (LCCC). Results: Intra- and interobserver mean differences for aortic diameter and true and false lumen volumes were generally within the limits of agreement and the a priori differences; the LCCC showed excellent agreement. Entry tear location, size, and number were difficult to measure in a repeatable manner, with inconsistent correlation coefficients, especially between the 2 observers. Conclusion: This protocol showed acceptable repeatability for aortic diameter and aortic volume measurements. Assessment of entry tears proved challenging and associated with less favorable results. Additionally, investigators are urged to be more transparent regarding the measurement methodology used in studies describing aortic dimensions.
Collapse
Affiliation(s)
- Arnoud V. Kamman
- Thoracic Aortic Research Center, Policlinico San Donato IRCCS, San Donato Milanese, Italy
- Department of Vascular Surgery, University Hospital Utrecht, the Netherlands
| | | | - Matteo Orrico
- Department of Vascular Surgery, San Filippo Neri Hospital, Rome, Italy
| | - Foeke J. H. Nauta
- Thoracic Aortic Research Center, Policlinico San Donato IRCCS, San Donato Milanese, Italy
- Department of Vascular Surgery, University Hospital Utrecht, the Netherlands
- Departments of Surgery and Biomedical Engineering, University of Michigan, Ann Arbor, MI, USA
| | - Robin H. Heijmen
- Department of Cardiothoracic Surgery, St. Antonius Hospital, Nieuwegein, the Netherlands
| | - Frans L. Moll
- Department of Vascular Surgery, University Hospital Utrecht, the Netherlands
| | - Santi Trimarchi
- Thoracic Aortic Research Center, Policlinico San Donato IRCCS, San Donato Milanese, Italy
| |
Collapse
|
56
|
Du ZK, Wang Y, Wang XZ, Jing QM, Han YL. Influence of distal extension of false lumen on adverse aortic events after TEVAR in patients with acute type B aortic dissection. Catheter Cardiovasc Interv 2016; 87 Suppl 1:599-607. [PMID: 26864376 DOI: 10.1002/ccd.26427] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2015] [Accepted: 01/03/2016] [Indexed: 11/12/2022]
Abstract
OBJECTIVE To investigate the clinical outcomes influenced by distal extension of false lumen in acute type B aortic dissection (TBAD) patients following thoracic endovascular aortic repair (TEVAR). METHODS From April 2002 to January 2013, 264 TBAD patients treated with TEVAR were retrospectively enrolled. The IIIa group exhibited a distal false lumen above the diaphragm (n = 70), and the IIIb group exhibited a distal false lumen under the diaphragm (n = 194). The morphological characteristics and adverse events (30-day and >30 days) were recorded and evaluated. RESULTS There were no significant differences between the two groups regarding the demographics, comorbidity profiles, or initial feature of computed tomography angiography. The incidence of true lumen compression and branch involvement were significantly increased in the IIIb group compared with the IIIa group (8.6% vs. 25.3%, respectively; 15.7% vs. 36.1%, respectively, both P < 0.05). The 30-day mortality rate was 1.0% (2/194) in the IIIb group, whereas the IIIa group was zero. The incidence of early adverse events, the 5-year cumulative freedom from adverse events, and the 5-year cumulative freedom from all-cause mortality rate were not significantly different between the IIIa and IIIb groups (2.9% vs. 6.7%, 81.4%, and 80.4%, and 95.7% vs. 93.8%, respectively, all P > 0.05). Log-rank tests also indicated there was no significant difference. CONCLUSIONS There was no significant difference between the IIIa and IIIb groups in the 5-year morality and adverse aortic events following TEVAR. The distal extension of false lumen prior to TEVAR does not influence the long-term morality and adverse aortic events in acute TBAD.
Collapse
Affiliation(s)
- Zhan-kui Du
- Department of Cardiology, Institute of Cardiovascular Research, General Hospital of Shenyang Military Region, Shenyang, Liaoning, 110840, China.,Department of Cardiology, Institute of Cardiovascular Research, the Second Hospital Affiliated to Xi'an Medical University, Xi'an, 710038, China
| | - Ya Wang
- Department of Cardiology, Institute of Cardiovascular Research, General Hospital of Shenyang Military Region, Shenyang, Liaoning, 110840, China
| | - Xiao-zeng Wang
- Department of Cardiology, Institute of Cardiovascular Research, General Hospital of Shenyang Military Region, Shenyang, Liaoning, 110840, China
| | - Quan-min Jing
- Department of Cardiology, Institute of Cardiovascular Research, General Hospital of Shenyang Military Region, Shenyang, Liaoning, 110840, China
| | - Ya-ling Han
- Department of Cardiology, Institute of Cardiovascular Research, General Hospital of Shenyang Military Region, Shenyang, Liaoning, 110840, China
| |
Collapse
|
57
|
Sakata K, Yamashita A, Takeuchi K, Matsuo T, Aoki M, Yoshimura N. Cardiac Arrest Due to Dynamic Obstruction of Aorta during Course of the Acute Type B Aortic Dissection. Ann Vasc Dis 2016; 8:321-3. [PMID: 26730259 DOI: 10.3400/avd.cr.15-00028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2015] [Accepted: 09/02/2015] [Indexed: 11/13/2022] Open
Abstract
Acute aortic occlusion is a catastrophic event requiring early recognition and intervention. The patient was diagnosed type B aortic dissection. He became anuric on the sixth day of illness and the femoral artery pulse was not palpable. Therefore the patient was conveyed to our hospital. During transfer, his blood pressure was suddenly elevated and later he was in cardiopulmonary arrest. After cardiopulmonary resuscitation, the heart resumed beating in several minutes. Acute dynamic obstruction was regarded as a cause of the cardiac arrest. A thoracic endovascular aortic repair was performed urgently. His postoperative period was uneventful and the patient was discharged without problems.
Collapse
Affiliation(s)
- Kimimasa Sakata
- Department of Thoracic and Cardiovascular Surgery, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, Toyama, Toyama, Japan
| | - Akio Yamashita
- Department of Thoracic and Cardiovascular Surgery, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, Toyama, Toyama, Japan
| | - Katsunori Takeuchi
- Department of Thoracic and Cardiovascular Surgery, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, Toyama, Toyama, Japan
| | - Tatsuro Matsuo
- Department of Thoracic and Cardiovascular Surgery, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, Toyama, Toyama, Japan
| | - Masaya Aoki
- Department of Thoracic and Cardiovascular Surgery, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, Toyama, Toyama, Japan
| | - Naoki Yoshimura
- Department of Thoracic and Cardiovascular Surgery, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, Toyama, Toyama, Japan
| |
Collapse
|
58
|
Mori K, Tamune H, Tanaka H, Nakamura M. Admission Values of D-dimer and C-reactive Protein (CRP) Predict the Long-term Outcomes in Acute Aortic Dissection. Intern Med 2016; 55:1837-43. [PMID: 27432090 DOI: 10.2169/internalmedicine.55.6404] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Objective Admission D-dimer and C-reactive protein (CRP) values have been reported to predict the short-term outcomes in acute aortic dissection (AAD). However, the association between D-dimer values and the long-term outcomes has not been investigated. Methods The primary endpoints included events determined to be all-cause death, recurrence of aortic dissection, aortic rupture, and surgical intervention for the aortic aneurysm following the first hospital discharge. We performed a receiver operating characteristic analysis and determined the optimal cut-off levels of admission D-dimer, admission CRP and peak CRP values in terms of the sensitivity and specificity for predicting the presence of events. Using the optimal cut-off values, we performed a multiple Cox analysis and investigated the hazard ratio of admission D-dimer, admission CRP and peak CRP. Patients We retrospectively identified 173 AAD patients hospitalized between January 2005 and December 2013. Results A multiple Cox regression analysis revealed that the hazard ratios were 3.4 for admission D-dimer [95% Confidence Interval (CI) 1.5 to 7.3, p=0.004] and 2.7 for admission CRP (95% CI 1.2 to 5.5, p=0.014). Conclusion Admission D-dimer and CRP values may predict the long-term outcomes in AAD. Moreover, admission D-dimer values may be a valuable marker to predict not only the short-term outcomes, but also the long-term outcomes in AAD.
Collapse
Affiliation(s)
- Kentaro Mori
- Department of Emergency Rescue, Tokyo Metropolitan Tama Medical Center, Japan
| | | | | | | |
Collapse
|
59
|
Afifi RO, Sandhu HK, Leake SS, Boutrous ML, Kumar V, Azizzadeh A, Charlton-Ouw KM, Saqib NU, Nguyen TC, Miller CC, Safi HJ, Estrera AL. Outcomes of Patients With Acute Type B (DeBakey III) Aortic Dissection: A 13-Year, Single-Center Experience. Circulation 2015; 132:748-54. [PMID: 26304666 PMCID: PMC4548541 DOI: 10.1161/circulationaha.115.015302] [Citation(s) in RCA: 97] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Background— Aortic dissection remains the most common aortic catastrophe. In the endovascular era, the management of acute type B aortic dissection (ATBAD) is undergoing dramatic changes. The aim of this study is to evaluate the long-term outcomes of patients with ATBAD who were treated at our center over a 13-year period. Methods and Results— We reviewed patients with ATBAD between 2001 and 2014, analyzing variables based on status (complicated [c] versus uncomplicated [u]) and treatment modalities. We defined cATBAD as rupture, expansion of diameter on imaging during the admission, persistent pain, or clinical malperfusion leading to a deficit in cerebral, spinal, visceral, renal, or peripheral vascular territories at presentation or during initial hospitalization. Postoperative outcomes were defined as deficits not present before the intervention. Outcomes were compared between the groups by use of Kaplan-Meier and descriptive statistics. We treated 442 patients with ATBAD. Of those 442, 60.6% had uATBAD and were treated medically, and 39.4% had cATBAD, of whom 39.0% were treated medically to 30.0% with open repair, 21.3% with thoracic endovascular aortic repair, and 9.7% with other open peripheral procedures. Intervention-free survival at 1 and 5 years was 84.8% and 62.7% for uATBAD, 61.8% and 44.0% for cATBAD-medical, 69.2% and 47.2% for cATBAD-open, and 68.0% and 42.5% for cATBAD–thoracic endovascular aortic repair, respectively (P=0.001). Overall survival was significantly related primarily to complicated presentation. Conclusions— In our experience, early and late outcomes of ATBAD were dependent on the presence of complications, with cATBAD faring worse. Although uATBAD was associated with favorable early survival, late complications still occurred, mandating radiographic surveillance and open or endovascular interventions. Prospective trials are required to better determine the optimal therapy for uATBAD.
Collapse
Affiliation(s)
- Rana O Afifi
- From the University of Texas Medical School at Houston and Memorial Hermann Heart & Vascular Institute, Houston
| | - Harleen K Sandhu
- From the University of Texas Medical School at Houston and Memorial Hermann Heart & Vascular Institute, Houston
| | - Samuel S Leake
- From the University of Texas Medical School at Houston and Memorial Hermann Heart & Vascular Institute, Houston
| | - Mina L Boutrous
- From the University of Texas Medical School at Houston and Memorial Hermann Heart & Vascular Institute, Houston
| | - Varsha Kumar
- From the University of Texas Medical School at Houston and Memorial Hermann Heart & Vascular Institute, Houston
| | - Ali Azizzadeh
- From the University of Texas Medical School at Houston and Memorial Hermann Heart & Vascular Institute, Houston
| | - Kristofer M Charlton-Ouw
- From the University of Texas Medical School at Houston and Memorial Hermann Heart & Vascular Institute, Houston
| | - Naveed U Saqib
- From the University of Texas Medical School at Houston and Memorial Hermann Heart & Vascular Institute, Houston
| | - Tom C Nguyen
- From the University of Texas Medical School at Houston and Memorial Hermann Heart & Vascular Institute, Houston
| | - Charles C Miller
- From the University of Texas Medical School at Houston and Memorial Hermann Heart & Vascular Institute, Houston
| | - Hazim J Safi
- From the University of Texas Medical School at Houston and Memorial Hermann Heart & Vascular Institute, Houston
| | - Anthony L Estrera
- From the University of Texas Medical School at Houston and Memorial Hermann Heart & Vascular Institute, Houston.
| |
Collapse
|
60
|
|
61
|
Abstract
The development of thoracic endovascular aortic repair (TEVAR) has allowed a minimally invasive approach for management of an array of thoracic aortic pathologies. Initially developed specifically for exclusion of thoracic aortic aneurysms, TEVAR is now used as an alternative to open surgery for a variety of disease pathologies due to the lower morbidity of this approach. Advances in endograft technology continue to broaden the applications of this technique.
Collapse
Affiliation(s)
- David A Nation
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Hospital of University of Pennsylvania, Philadelphia, Pennsylvania
| | - Grace J Wang
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Hospital of University of Pennsylvania, Philadelphia, Pennsylvania
| |
Collapse
|
62
|
Conrad MF, Carvalho S, Ergul E, Kwolek CJ, Lancaster RT, Patel VI, Cambria RP. Late aortic remodeling persists in the stented segment after endovascular repair of acute complicated type B aortic dissection. J Vasc Surg 2015; 62:600-5. [DOI: 10.1016/j.jvs.2015.03.064] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2015] [Accepted: 03/20/2015] [Indexed: 11/29/2022]
|
63
|
Kagawa Y, Ota S, Hoshino K, Yamada N, Nakamura M, Ito M. Acute Pulmonary Thromboembolism and Deep Vein Thrombosis during the Medical Treatment of Acute Aortic Dissection was Successfully Treated by the Combination of Inferior Vena Cava Filter Installation and Anti-Coagulant Therapy: A Case Report. Ann Vasc Dis 2015; 8:36-9. [PMID: 25848430 DOI: 10.3400/avd.cr.14-00083] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2014] [Accepted: 11/16/2014] [Indexed: 11/13/2022] Open
Abstract
A 71-year-old woman was admitted with Stanford type A acute aortic dissection (AAD). Computed tomography (CT) revealed thrombosis of the false lumen, and we planned to treat medically. She developed transient pleural effusion and hypoxemia, which persisted despite her pleural effusion disappeared. We performed CT and found a large thrombus in the pulmonary artery and femoral vein. We administered low dose- unfractionated heparin and installed a retrievable inferior vena cava filter, which caused the thrombus in the pulmonary artery to disappeared without exacerbating AAD. Our strategy seems to be suitable for acute pulmonary thromboembolism that occurs during the treatment of AAD.
Collapse
Affiliation(s)
- Yoshihiko Kagawa
- Department of Cardiology and Nephrology, Mie University Graduate School of Medicine, Tsu, Mie, Japan
| | - Satoshi Ota
- Department of Cardiology, Suzuka General Hospital, Suzuka, Mie, Japan
| | - Kozo Hoshino
- Department of Cardiology, Nagai Hospital, Tsu, Mie, Japan
| | - Norikazu Yamada
- Department of Cardiology and Nephrology, Mie University Graduate School of Medicine, Tsu, Mie, Japan
| | - Mashio Nakamura
- Department of Cardiology and Nephrology, Mie University Graduate School of Medicine, Tsu, Mie, Japan
| | - Masaaki Ito
- Department of Cardiology and Nephrology, Mie University Graduate School of Medicine, Tsu, Mie, Japan
| |
Collapse
|
64
|
|
65
|
Teraa M, van Herwaarden JA, Trimarchi S, Moll FL. Morphologic characteristics for treatment guidance in uncomplicated acute type B aortic dissection. Circulation 2015; 130:1723-5. [PMID: 25366834 DOI: 10.1161/circulationaha.114.010362] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Martin Teraa
- From the Department of Vascular Surgery, University Medical Center Utrecht, Utrecht, The Netherlands (M.T., J.A.v.H., F.L.M.); Thoracic Aortic Research Center, Policlinico San Donato Istituti di Ricovero e Cura a Carattere Scientifico, Milan, Italy (S.T.).
| | - Joost A van Herwaarden
- From the Department of Vascular Surgery, University Medical Center Utrecht, Utrecht, The Netherlands (M.T., J.A.v.H., F.L.M.); Thoracic Aortic Research Center, Policlinico San Donato Istituti di Ricovero e Cura a Carattere Scientifico, Milan, Italy (S.T.)
| | - Santi Trimarchi
- From the Department of Vascular Surgery, University Medical Center Utrecht, Utrecht, The Netherlands (M.T., J.A.v.H., F.L.M.); Thoracic Aortic Research Center, Policlinico San Donato Istituti di Ricovero e Cura a Carattere Scientifico, Milan, Italy (S.T.)
| | - Frans L Moll
- From the Department of Vascular Surgery, University Medical Center Utrecht, Utrecht, The Netherlands (M.T., J.A.v.H., F.L.M.); Thoracic Aortic Research Center, Policlinico San Donato Istituti di Ricovero e Cura a Carattere Scientifico, Milan, Italy (S.T.)
| |
Collapse
|
66
|
Estrera AL, Jan A, Sandhu H, Shalhub S, Medina-Castro M, Nguyen TC, Azizzadeh A, Charlton-Ouw K, Miller CC, Safi HJ. Outcomes of Open Repair for Chronic Descending Thoracic Aortic Dissection. Ann Thorac Surg 2015; 99:786-93; discussion 794. [DOI: 10.1016/j.athoracsur.2014.08.077] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2014] [Revised: 07/23/2014] [Accepted: 08/15/2014] [Indexed: 11/30/2022]
|
67
|
Akutsu K, Yoshino H, Tobaru T, Hagiya K, Watanabe Y, Tanaka K, Koyama N, Yamamoto T, Nagao K, Takayama M. Acute type B aortic dissection with communicating vs. non-communicating false lumen. Circ J 2015; 79:567-73. [PMID: 25746541 DOI: 10.1253/circj.cj-14-0828] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND In practice, patients with acute aortic dissection (AAD) are generally divided into 2 groups according to the status of the false lumen: non-communicating or communicating. The similarities and differences between the 2 groups, however, have not been fully determined in a large population. METHODS AND RESULTS: We studied 502 patients with Stanford type B AAD. Clinical background at symptom onset was compared, and similarities and differences characterized, for patients with non-communicating (NC group, n=288) vs. communicating (C group, n=214) false lumens. Time of day (00.00-06.00 hours, 06.00-12.00 hours, 12.00-18.00 hours, and 18.00-24.00 hours) and extent of physical activity (extreme exertion, slight exertion, at rest, and sleeping) at symptom onset were similar between groups. Patients in the NC group were older (mean age, 71±11 years vs. 64±14 years, P<0.01) and had lower prevalence of distally extended aortic dissection (26% vs. 8%, P<0.01) and deaths in hospital (2% vs. 7%, P=0.011) than those in the C group. CONCLUSIONS At symptom onset, clinical circumstances and physical activity were similar between the groups, and old age and a background of DeBakey IIIa aortic dissection may be associated with determination of false lumen status. The outcome in the NC group was better than in the C group.
Collapse
Affiliation(s)
- Koichi Akutsu
- Tokyo CCU Network Scientific Committee; Division of Cardiovascular Intensive Care, Nippon Medical School Hospital, 1-1-5 Sendagi, Bunkyo-ku 113-8603.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
68
|
|
69
|
Grommes J, Greiner A, Bendermacher B, Erlmeier M, Frech A, Belau P, Kennes LN, Fraedrich G, Schurink GW, Jacobs MJ, Klocker J. Risk factors for mortality and failure of conservative treatment after aortic type B dissection. J Thorac Cardiovasc Surg 2014; 148:2155-2160.e1. [DOI: 10.1016/j.jtcvs.2014.03.053] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2013] [Revised: 03/25/2014] [Accepted: 03/28/2014] [Indexed: 10/25/2022]
|
70
|
Evangelista A, Galuppo V, Gruosso D, Cuéllar H, Teixidó G, Rodríguez-Palomares J. Role of entry tear size in type B aortic dissection. Ann Cardiothorac Surg 2014; 3:403-5. [PMID: 25133104 DOI: 10.3978/j.issn.2225-319x.2014.07.03] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2014] [Accepted: 07/15/2014] [Indexed: 11/14/2022]
Affiliation(s)
- Artur Evangelista
- 1 Department de Cardiologia, Hospital Vall d'Hebron, Universitat Autònoma de Barcelona, P° Vall d'Hebron 119, 08035 Barcelona, Spain ; 2 Institut de Diagnòstic per la Imatge, Hospital Vall d'Hebron, Barcelona 08035, Spain
| | - Valentina Galuppo
- 1 Department de Cardiologia, Hospital Vall d'Hebron, Universitat Autònoma de Barcelona, P° Vall d'Hebron 119, 08035 Barcelona, Spain ; 2 Institut de Diagnòstic per la Imatge, Hospital Vall d'Hebron, Barcelona 08035, Spain
| | - Domenico Gruosso
- 1 Department de Cardiologia, Hospital Vall d'Hebron, Universitat Autònoma de Barcelona, P° Vall d'Hebron 119, 08035 Barcelona, Spain ; 2 Institut de Diagnòstic per la Imatge, Hospital Vall d'Hebron, Barcelona 08035, Spain
| | - Hug Cuéllar
- 1 Department de Cardiologia, Hospital Vall d'Hebron, Universitat Autònoma de Barcelona, P° Vall d'Hebron 119, 08035 Barcelona, Spain ; 2 Institut de Diagnòstic per la Imatge, Hospital Vall d'Hebron, Barcelona 08035, Spain
| | - Gisela Teixidó
- 1 Department de Cardiologia, Hospital Vall d'Hebron, Universitat Autònoma de Barcelona, P° Vall d'Hebron 119, 08035 Barcelona, Spain ; 2 Institut de Diagnòstic per la Imatge, Hospital Vall d'Hebron, Barcelona 08035, Spain
| | - José Rodríguez-Palomares
- 1 Department de Cardiologia, Hospital Vall d'Hebron, Universitat Autònoma de Barcelona, P° Vall d'Hebron 119, 08035 Barcelona, Spain ; 2 Institut de Diagnòstic per la Imatge, Hospital Vall d'Hebron, Barcelona 08035, Spain
| |
Collapse
|
71
|
Kim JB, Sundt TM. Best surgical option for arch extension of type B aortic dissection: the open approach. Ann Cardiothorac Surg 2014; 3:406-12. [PMID: 25133105 DOI: 10.3978/j.issn.2225-319x.2014.06.02] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2014] [Accepted: 05/27/2014] [Indexed: 12/21/2022]
Abstract
Arch extension of aortic dissection (AD) is reported to occur in 4-25% of patients presenting with acute type B AD. The DeBakey and Stanford classifications do not specifically account for this subset, however, recent studies have demonstrated that the prognosis of patients with arch extension in acute type B AD is virtually identical to that of others with type B AD. In this sense, it seems reasonable to extend the general management principles that are applied to classic acute type B AD even to patients with arch extension. This may be because even in patients with arch extension, most complications occur at locations distal to the arch, and therefore treatment of these patients is similar to that of complicated type B AD, namely thoracic endovascular aortic repair (TEVAR). Conversely, 10% of patients with acute type B AD and arch extension develop complications that are directly related to the arch pathology. This clinical scenario generally necessitates surgical arch repair through a sternotomy approach. The frozen elephant trunk technique combined with arch repair is a very reasonable option to treat this unique clinical entity that involves relatively distal locations of the aortic diseases. Combined arch and descending aorta replacement through thoracotomy is an alternative option particularly when the anatomical features of the target lesions are not suitable for a sternotomy approach or TEVAR. Nonetheless, the reported mortality associated with this approach has been exceedingly high. Hybrid arch repair is another consideration in treating these patients to reduce the treatment-related mortality and morbidity, especially when the arch pathology is limited to the distal part. Nevertheless, the safety and efficacy of this procedure in cases with more extensive arch involvement needs to be assessed in further studies in comparison with other treatment modalities.
Collapse
Affiliation(s)
- Joon Bum Kim
- 1 Division of Cardiac Surgery and Thoracic Aorta Center, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA ; 2 Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Thoralf M Sundt
- 1 Division of Cardiac Surgery and Thoracic Aorta Center, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA ; 2 Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| |
Collapse
|
72
|
A clinical decision model for selecting the most appropriate therapy for uncomplicated chronic dissections of the descending aorta. J Vasc Surg 2014; 60:20-30. [DOI: 10.1016/j.jvs.2014.01.054] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2013] [Revised: 01/21/2014] [Accepted: 01/21/2014] [Indexed: 11/24/2022]
|
73
|
Lower heart rate in the early postoperative period does not correlate with long-term outcomes after repair of type A acute aortic dissection. Heart Vessels 2014; 30:355-61. [PMID: 24566590 PMCID: PMC4427614 DOI: 10.1007/s00380-014-0486-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2013] [Accepted: 02/07/2014] [Indexed: 11/22/2022]
Abstract
Little evidence exists regarding the need for a reduction in postoperative heart rate after repair of type A acute aortic dissection. This single-center retrospective study was conducted to determine if lower heart rate during the early postoperative phase is associated with improved long-term outcomes after surgery for patients with type A acute aortic dissection. We reviewed 434 patients who underwent aortic repair between 1990 and 2011. Based on the average heart rate on postoperative days 1, 3, 5, and 7, 434 patients were divided into four groups, less than 70, 70–79, 80–89, and greater than 90 beats per minute. The mean age was 63.3 ± 12.1 years. During a median follow-up of 52 months (range 16–102), 10-year survival in all groups was 67 %, and the 10-year aortic event-free rate was 79 %. The probability of survival and being aortic event-free using Kaplan–Meier estimates reveal that there is no significant difference when stratified by heart rate. Cox proportional regression analysis for 10-year mortality shows that significant predictors of mortality are age [Hazard Ratio (HR) 1.04; 95 % confidence interval (CI) 1.07–1.06; p = 0.001] and perioperative stroke (HR 2.30; 95 % CI 1.18–4.50; p = 0.024). Neither stratified heart rate around the time of surgery nor beta-blocker use at the time of discharge was significant. There is no association between stratified heart rate in the perioperative period with long-term outcomes after repair of type A acute aortic dissection. These findings need clarification with further clinical trials.
Collapse
|
74
|
Fukuizumi A, Akutsu K, Tokita Y, Yamamoto T, Shimizu W, Mizuno K, Tanaka K. Surgical thrombectomy for right heart thrombus with acute aortic dissection. Ann Thorac Cardiovasc Surg 2014; 20 Suppl:937-40. [PMID: 24492169 DOI: 10.5761/atcs.cr.13-00218] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
An 81-year-old female complaining of severe back pain was admitted to hospital and diagnosed with acute type A aortic dissection with a thrombosed false lumen. Aggressive antihypertensive therapy was selected. On day 8, computed tomography showed pulmonary artery thrombus, and transthoracic echocardiography showed a 76×70 mm worm-like floating right heart thrombus. Thrombolytic therapy is reported to be the optimal treatment for patients with pulmonary embolism and floating right heart thrombus, but is contraindicated in acute aortic dissection. The patient underwent surgical thrombectomy, which revealed thrombus entrapped in the Chiari network. An inferior vena cava filter was placed. The patient recovered uneventfully and was discharged home after initiation of warfarin therapy.
Collapse
Affiliation(s)
- Aya Fukuizumi
- Division of Intensive and Cardiovascular Care Unit, Nippon Medical School Hospital, Nippon Medical School, Tokyo, Japan
| | | | | | | | | | | | | |
Collapse
|
75
|
Brunkwall J, Lübke T, Power AH, Forbes TL. Debate: Whether level I evidence comparing thoracic endovascular repair and medical management is necessary for uncomplicated type B aortic dissections. J Vasc Surg 2013; 58:836-41. [PMID: 23972250 DOI: 10.1016/j.jvs.2013.06.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Type B aortic dissections continue to be one of the most challenging clinical scenarios confronting vascular surgeons. In the era of open surgery, the therapeutic options were limited to medical management of hypertension and large open thoracoabdominal operations. In the current endovascular era, the operative strategies have become less invasive but the questions regarding therapeutic approaches have become more numerous and complex. In patients with acute uncomplicated type B aortic dissections, we are still unsure as to which patients are best treated with medical therapy alone or with the addition of early endovascular repair. Data from single centers and registries have provided some guidance; however, questions remain. Perhaps level 1 evidence from well-designed randomized controlled trials will answer all of our questions. This is the topic of the current debate.
Collapse
Affiliation(s)
- Jan Brunkwall
- Department of Vascular Surgery, University Clinics, University of Cologne, Cologne, Germany.
| | | | | | | |
Collapse
|
76
|
Abstract
Aortic dissection is a devastating cardiovascular condition and represents the most common aortic emergency. Outcome is determined by the type and extent of dissection and the presence of associated complications requiring early diagnosis and treatment. Aortic dissection is defined as acute within 14 days from onset and chronic after that time period. The natural course of type B dissection is determined by 2 elements, early and chronic complications. An uncomplicated acute type B dissection is less frequently lethal but it is not totally benign. Some peculiar issues must be taken into account, such as the high probability of complications development in a dissected aorta and the poor long-term prognosis on medical treatment alone. Then, it would be helpful to identify which patients with uncomplicated type B dissection will have a poorest aortic prognosis over time in order to apply an early intervention.
Collapse
Affiliation(s)
- Laura Capoccia
- Vascular Surgery Division, Department of Surgery "Paride Stefanini", Policlinico Umberto I, "Sapienza" University of Rome, Rome, Italy
| | - Vicente Riambau
- Vascular Surgery Department, Thorax Institute, Hospital Clinic, University of Barcelona, Barcelona, Spain
| |
Collapse
|
77
|
Part two: against the motion. We do not need level 1 evidence comparing best medical treatment with TEVAR in patients with uncomplicated type B aortic dissection. Eur J Vasc Endovasc Surg 2013; 46:278-9. [PMID: 23835107 DOI: 10.1016/j.ejvs.2013.06.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
|
78
|
Abstract
Patients with aortic disease are some of the highest acuity patients that emergency clinicians encounter. Dissection is the most common aortic catastrophe and involves separation of the aortic layers in a longitudinal fashion leading to diminished perfusion and systemic ischemia. Characteristics of pain, branch vessel involvement, and incidence lead to an understanding of patient presentation, morbidity, and mortality. Diagnosis, selection of diagnostic studies, the degree of preoperative ischemia, and risk of operative mortality can be accomplished using validated clinical decision tools. Emergency interventions are guided by the type of dissection according to the Stanford classification system. Medical management includes pain control and anti-impulse, antihypertensive therapy through vasodilatation and blockage of the sympathetic β-response. The patient may then be evaluated for open surgical intervention, aortic fenestration, endovascularly placed stent grafts, or a combination possibly in a staged approach. Morbidity includes rupture, stroke, paraplegia, acute renal failure, bowel ischemia, and peripheral ischemia.
Collapse
|
79
|
Nienaber CA, Akin I, Kische S, Ince H, Chatterjee T. [Stent graft of the thoracic aorta]. Internist (Berl) 2013; 54:561-71. [PMID: 23588784 DOI: 10.1007/s00108-012-3219-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Considering the demographic changes in our society and the proliferation of imaging-based improved diagnostics, both acute and chronic aortic diseases attract increasing attention and require dedicated care. Cardiac as well as vascular surgery used to represent the gold standards for therapeutic management of pathologies of the ascending aorta and the arch; however, the technological evolution of endoluminal strategies has had a serious impact on the treatment of the descending aorta, the aortic arch in combination with vascular debranching or bypass, and in selected cases even on managing pathologies of the ascending aorta. Although several case series and meta-analyses of published observations hint towards superiority of endografting in comparison to open surgical repair, the affected usually multimorbid patients with highly complex aortic disease should be subjected to an individual evaluation by a team of cardiologists, cardiac and vascular surgeons as well as imaging specialists; a dedicated individualized treatment concept in highly experienced centers of excellence is likely to provide the best results for such challenging patients.
Collapse
Affiliation(s)
- C A Nienaber
- Unversitäres Herzzentrum Rostock, Medizinische Klinik I, Universität Rostock, Ernst-Heydemann-Str. 6, 18057, Rostock, Deutschland.
| | | | | | | | | |
Collapse
|
80
|
Ateş F, Yaraş S, Sarıtaş B, Sezgin O, Altıntaş E. Extensive Intestinal Ischemia After Acute Aortic Dissection. ELECTRONIC JOURNAL OF GENERAL MEDICINE 2013. [DOI: 10.29333/ejgm/82306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
|
81
|
|
82
|
Vollroth M, Seeburger J, Kiefer P, Hoebartner M, Bausback Y, Garbade J, Lehmkuhl L, Mohr FW. Interdisciplinary team approach for complicated type B aortic dissection with concomitant hematothorax by endovascular stent grafting and left side mini thoracotomy: a case report. J Cardiothorac Surg 2012; 7:111. [PMID: 23062204 PMCID: PMC3533757 DOI: 10.1186/1749-8090-7-111] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2012] [Accepted: 09/23/2012] [Indexed: 11/13/2022] Open
Abstract
Due to high mortality rates in surgical treatment, total endovascular stent grafting has become a promising therapeutic option in patients with acute aortic dissection type B. In our case, a 76- year- old patient with acute ruptured aortic dissection type B and hematothorax achieved concomitant total endovascular stent grafting and left side mini thoracotomy. With moderate neurologic impairment he was discharged from hospital after 20 days. This case shows that early mortality of live threatening acute aortic dissection type B with hemorrhagic pleural effusion may be reduced by total endovascular stent grafting and concomitant mini thoracotomy.
Collapse
Affiliation(s)
- Marcel Vollroth
- Department of Cardiac Surgery, Heartcenter Leipzig University, Struempellstrasse 39, Leipzig, 04289, Germany.
| | | | | | | | | | | | | | | |
Collapse
|
83
|
Sarafidis PA, Georgianos PI, Malindretos P, Liakopoulos V. Pharmacological management of hypertensive emergencies and urgencies: focus on newer agents. Expert Opin Investig Drugs 2012; 21:1089-106. [PMID: 22667825 DOI: 10.1517/13543784.2012.693477] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
INTRODUCTION Hypertensive crises are categorized as hypertensive emergencies and urgencies depending on the presence of acute target-organ damage; the former are potentially life-threatening medical conditions, requiring urgent treatment under close monitoring. Although several short-acting intravenous antihypertensive agents are approved for this purpose, until recently little evidence from proper trials on the relative merits of different therapies was available. AREAS COVERED This article discusses in brief the pathophysiology, epidemiology and diagnostic approach of hypertensive crises and provides an extensive overview of established and emerging pharmacological agents for the treatment of patients with hypertensive emergencies and urgencies. EXPERT OPINION Agents such as sodium nitroprusside, nitroglycerin and hydralazine have been used for many years as first-line options for patients with hypertensive emergencies, although their potential adverse effects and difficulties in use were well known. With time, equally potent and less toxic alternatives, including nicardipine, fenoldopam, labetalol and esmolol are increasingly used worldwide. Recently, clevidipine, a third-generation dihydropyridine calcium-channel blocker with unique pharmacodynamic and pharmacokinetic properties was added to our therapeutic armamentarium and was shown in clinical trials to reduce mortality when compared with nitroprusside. In view of such evidence, a change in pharmacological treatment practices for hypertensive crises toward newer and safer agents is warranted.
Collapse
Affiliation(s)
- Pantelis A Sarafidis
- Aristotle University of Thessaloniki, AHEPA Hospital, 1st Department of Medicine, Section of Nephrology and Hypertension, Thessaloniki, Greece.
| | | | | | | |
Collapse
|
84
|
Murashita T, Ogino H, Matsuda H, Sasaki H, Tanaka H, Iba Y, Domae K, Fujiwara T. Clinical Outcome of Emergency Surgery for Complicated Acute Type B Aortic Dissection. Circ J 2012; 76:650-4. [DOI: 10.1253/circj.cj-11-0982] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Takashi Murashita
- Department of Cardiovascular Surgery, Kobe City Medical Center General Hospital
| | - Hitoshi Ogino
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center
| | - Hitoshi Matsuda
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center
| | - Hiroaki Sasaki
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center
| | - Hiroshi Tanaka
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center
| | - Yutaka Iba
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center
| | - Keitaro Domae
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center
| | - Tatsuki Fujiwara
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center
| |
Collapse
|
85
|
|
86
|
|
87
|
Uchida N, Katayama A, Tamura K, Sutoh M, Murao N, Kuraoka M. Early entry closure for acute type B aortic dissection by open stent grafting. Gen Thorac Cardiovasc Surg 2011; 59:329-34. [PMID: 21547626 DOI: 10.1007/s11748-010-0749-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2010] [Accepted: 11/24/2010] [Indexed: 11/29/2022]
Abstract
PURPOSE We describe the long-term efficacy of early entry closure for acute type B aortic dissection by open stent grafting based on long-term results and changes in the false lumen on enhanced computed tomography (CT). METHODS We performed open stent grafting for acute type B aortic dissection in 28 28 patients between 1998 a 2008. They included 14 patients with complicated type B aortic dissection (11 patients with limb and/or visceral ischemia and 4 patients with impending rupture). Uncomplicated type B aortic dissection was present in 14 patients, including 4 patients with an ulcer-like projection and 10 patients who had stable dissection with a patent false lumen. RESULTS Two patients who had the ischemic type died within 30 days. Postoperative complications occurred in two patients, including one case of paraplegia and one of mediastinitis. Two more deaths occurred during a median follow-up period of 45 months (range 6-114 months), with one related to open stent-graft infection and one due to pneumonia. The overall survival rate 5 years after open stent grafting was 77%. According to follow-up by CT, the false lumen was completely thrombosed and obliterated in all 26 patients with stent grafts. CONCLUSION Early entry closure for both complicated and uncomplicated acute type B aortic dissection with an open stent graft has an acceptable early outcome and provides a high aortic remodeling rate.
Collapse
Affiliation(s)
- Naomichi Uchida
- Division of Cardiovascular Surgery, Hiroshima Asa General Hospital, 2-1-1 Kabe-minami, Asa-kita-ku, Hiroshima 731-0293, Japan.
| | | | | | | | | | | |
Collapse
|
88
|
|
89
|
Jo Y, Anzai T, Ueno K, Kaneko H, Kohno T, Sugano Y, Maekawa Y, Yoshikawa T, Shimizu H, Yozu R, Ogawa S. Re-elevation of D-dimer as a predictor of re-dissection and venous thromboembolism after Stanford type B acute aortic dissection. Heart Vessels 2010; 25:509-14. [PMID: 20936292 DOI: 10.1007/s00380-010-0028-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2009] [Accepted: 01/21/2010] [Indexed: 10/19/2022]
Abstract
D-dimer measurement is a useful complementary initial diagnostic marker in patients with acute aortic dissection (AAD). However, it has not been clarified whether serial measurements of D-dimer are useful during in-hospital management of Stanford type B AAD. We studied 30 patients who were admitted with diagnosis of Stanford type B AAD and treated conservatively. D-dimer was serially measured on admission and then every 5 days during hospitalization. Patients were divided into two groups according to the presence or absence of re-elevation of D-dimer during hospitalization, in which D-dimer transition were biphasic and latter peak >10.0 μg/ml. Re-elevation of D-dimer was observed in 17 patients. There were no differences in atherosclerotic risk factors, blood pressure on admission, D-dimer level on admission, extent of AAD, and false lumen patency. Patients with re-elevation of D-dimer showed higher incidence of re-dissection and/or venous thromboembolism (VTE). Peak D-dimer level in patients with re-dissection and/or VTE was significantly higher than that without these complications (p = 0.005). In conclusion, serial measurements of D-dimer are useful for early detection of re-dissection or VTE in patients with Stanford type B AAD, which may contribute to the prevention of disastrous consequences such as pulmonary embolism and extension of AAD.
Collapse
Affiliation(s)
- Yusuke Jo
- Division of Cardiology, Department of Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
90
|
Bhamidipati CM, Ailawadi G. Acute complicated and uncomplicated type III aortic dissection: an endovascular perspective. Semin Thorac Cardiovasc Surg 2010; 21:373-86. [PMID: 20226352 DOI: 10.1053/j.semtcvs.2009.11.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/24/2009] [Indexed: 11/11/2022]
Abstract
Type III aortic dissection is associated with high morbidity and mortality. There is a shifting paradigm in the treatment of complicated and uncomplicated acute type III aortic dissection toward earlier endovascular repair. In this review, the authors present the current perspective on the endovascular management of acute complicated and uncomplicated type III aortic dissection.
Collapse
Affiliation(s)
- Castigliano M Bhamidipati
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery, University of Virginia School of Medicine, Charlottesville, Virginia, USA
| | | |
Collapse
|
91
|
Andritsos M, Desai ND, Grewal A, Augoustides JG. Innovations in Aortic Disease Management: The Descending Aorta. J Cardiothorac Vasc Anesth 2010; 24:523-9. [DOI: 10.1053/j.jvca.2010.02.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2010] [Indexed: 11/11/2022]
|
92
|
Hiratzka LF, Bakris GL, Beckman JA, Bersin RM, Carr VF, Casey DE, Eagle KA, Hermann LK, Isselbacher EM, Kazerooni EA, Kouchoukos NT, Lytle BW, Milewicz DM, Reich DL, Sen S, Shinn JA, Svensson LG, Williams DM. 2010 ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM Guidelines for the diagnosis and management of patients with thoracic aortic disease. A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines, American Association for Thoracic Surgery, American College of Radiology,American Stroke Association, Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, Society of Interventional Radiology, Society of Thoracic Surgeons,and Society for Vascular Medicine. J Am Coll Cardiol 2010; 55:e27-e129. [PMID: 20359588 DOI: 10.1016/j.jacc.2010.02.015] [Citation(s) in RCA: 998] [Impact Index Per Article: 71.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
|
93
|
Mastroroberto P, Onorati F, Zofrea S, Renzulli A, Indolfi C. Outcome of open and endovascular repair in acute type B aortic dissection: a retrospective and observational study. J Cardiothorac Surg 2010; 5:23. [PMID: 20380711 PMCID: PMC2856556 DOI: 10.1186/1749-8090-5-23] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2009] [Accepted: 04/09/2010] [Indexed: 12/02/2022] Open
Abstract
Background The aim of the study was to analyze surgical and endovascular results in the treatment of acute type B aortic dissection (B AAD). Methods Retrospective and observational analysis with patient inclusion between January 2001-December 2008 and follow-up ranged from 2 to 96 months (median = 47.2) was performed. Out of 51 consecutive patients with B AAD, 11 (21.6%) had to undergo open surgery (OS) and 13 (25.5%) endovascular treatment (TEVAR). Results There was a significantly difference in early mortality in the TEVAR group (0/13,0%) vs OS group (4/11,36.4%, P < 0.05) and in the incidence of paraplegia/paraparesis (OS 2,28.6% vs TEVAR 1,7.7%, P < 0.05), renal failure (OS 3, 42.8% vs TEVAR 1, 7.7%, P < 0.05), respiratory failure (OS 2,28.6% vs TEVAR 1,7.7%, P < 0.05) and cerebrovascular accident (OS 1,14.3% vs TEVAR 0,0%, P < 0.05). The late mortality at a follow-up was 30.8% (4/13) in the TEVAR group and 42.8% (3/7) in the OS group, respectively (P = not significant). The cumulative survival rate after 1, 3 and 8 years was 93%, 84%, and 69% in the TEVAR group and 86%, 71% and 57% in the OS group, respectively. Endoleaks were diagnosed in 2/13 endovascular patients (15.4%). Conclusions TEVAR group had a significantly reduction in early mortality and postoperative complications. No significant differences were found in terms of cumulative survival at follow-up. On this basis TEVAR could be considered an option in the treatment of these complex cases with all proper reservation especially related to the small sample sizes examined.
Collapse
Affiliation(s)
- Pasquale Mastroroberto
- Department of Experimental and Clinical Medicine, Cardiovascular Surgery Unit University Magna Graecia, viale Europa, 88100 Catanzaro, Italy.
| | | | | | | | | |
Collapse
|
94
|
2010 ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM Guidelines for the Diagnosis and Management of Patients With Thoracic Aortic Disease: Executive Summary. J Am Coll Cardiol 2010. [DOI: 10.1016/j.jacc.2010.02.010] [Citation(s) in RCA: 136] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
|
95
|
Abstract
Aortic dissection is a rare, potentially catastrophic vascular emergency. Early recognition of the clinical manifestations, rapid confirmation using imaging modalities, urgent administration of appropriate medication and expedient selection of definitive long-term therapy are key to preserving life and reducing morbidity. In recent years it has become increasingly clear that there is a relation between cocaine and aortic dissection. Cocaine serves as both a predisposing factor to aortic dissection due to its effect on aortic connective tissue and as a precipitating factor due to its propensity to produce abrupt and severe hypertension. While similarities exist in the clinical features and diagnostic methods between cocaine-related aortic dissection and aortic dissection unrelated to cocaine use, there are important differences in management between these two syndromes which are rooted in the pharmacology and physiology of cocaine. An understanding of these differences is key to effective early and long-term management of cocaine-related aortic dissection.
Collapse
Affiliation(s)
- Avneet Singh
- Department of Medicine, Long Island Jewish Medical Center, New Hyde Park, NY, USA
| | - Azamuddin Khaja
- Division of Cardiology, University of Missouri-Columbia School of Medicine, Columbia, MO, USA
| | - Martin A Alpert
- Division of Cardiology, University of Missouri-Columbia School of Medicine, Columbia, MO, USA,
| |
Collapse
|
96
|
Hiratzka LF, Bakris GL, Beckman JA, Bersin RM, Carr VF, Casey DE, Eagle KA, Hermann LK, Isselbacher EM, Kazerooni EA, Kouchoukos NT, Lytle BW, Milewicz DM, Reich DL, Sen S, Shinn JA, Svensson LG, Williams DM, Jacobs AK, Smith SC, Anderson JL, Adams CD, Buller CE, Creager MA, Ettinger SM, Guyton RA, Halperin JL, Hunt SA, Krumholz HM, Kushner FG, Lytle BW, Nishimura R, Page RL, Riegel B, Stevenson WG, Tarkington LG, Yancy CW. 2010 ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM Guidelines for the Diagnosis and Management of Patients With Thoracic Aortic Disease: Executive Summary. Catheter Cardiovasc Interv 2010; 76:E43-86. [DOI: 10.1002/ccd.22537] [Citation(s) in RCA: 225] [Impact Index Per Article: 16.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
|
97
|
Tang DG, Dake MD. TEVAR for acute uncomplicated aortic dissection: immediate repair versus medical therapy. Semin Vasc Surg 2009; 22:145-51. [PMID: 19765524 DOI: 10.1053/j.semvascsurg.2009.07.005] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Medical management remains the standard treatment modality for acute uncomplicated descending aortic dissections. Intervention (by either open surgery or an endovascular approach) is currently reserved for patients who present with or subsequently develop complications (ie, complicated dissections). Despite the success of medical therapy in the acute management of uncomplicated dissection, long-term morbidity and mortality are far from ideal. The introduction of thoracic endovascular aortic repair (TEVAR) has been associated with reductions in morbidity and mortality in the treatment of complicated dissections. There is limited data regarding TEVAR for acute uncomplicated dissections. Early results from the INSTEAD (Investigation of Stent Grafts in Patients with Type B Aortic Dissection) trial, a randomized trial for TEVAR in subacute/chronic uncomplicated dissections, were not favorable. The ADSORB (Acute Uncomplicated Aortic Dissection Type B: Evaluating Stent-Graft Placement or Best Medical Treatment Alone) trial, a randomized trial for TEVAR in acute dissections, is currently underway. Nonetheless, current data available, including multiple reports proposing a variety of predictive factors, suggest that there may be a subset of higher-risk patients with acute uncomplicated dissections who could benefit from TEVAR.
Collapse
Affiliation(s)
- Daniel G Tang
- Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, CA 94306, USA
| | | |
Collapse
|
98
|
Niino T, Hata M, Sezai A, Yoshitake I, Unosawa S, Shimura K, Osaka S, Minami K. Optimal Clinical Pathway for the Patient With Type B Acute Aortic Dissection. Circ J 2009; 73:264-8. [DOI: 10.1253/circj.cj-08-0319] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Tetsuya Niino
- Department of Cardiovascular Surgery, Nihon University School of Medicine
| | - Mitsumasa Hata
- Department of Cardiovascular Surgery, Nihon University School of Medicine
| | - Akira Sezai
- Department of Cardiovascular Surgery, Nihon University School of Medicine
| | - Isamu Yoshitake
- Department of Cardiovascular Surgery, Nihon University School of Medicine
| | - Satoshi Unosawa
- Department of Cardiovascular Surgery, Nihon University School of Medicine
| | - Kazuma Shimura
- Department of Cardiovascular Surgery, Nihon University School of Medicine
| | - Shunji Osaka
- Department of Cardiovascular Surgery, Nihon University School of Medicine
| | - Kazutomo Minami
- Department of Cardiovascular Surgery, Nihon University School of Medicine
| |
Collapse
|
99
|
Lakshmanan R, Aung M, Hoong CK. Limb ischaemia in a Stanford B aortic dissection into an abdominal aortic aneurysm. ANZ J Surg 2008; 78:660-1. [PMID: 18796022 DOI: 10.1111/j.1445-2197.2008.04610.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Aortic dissection presenting with acute lower limb ischaemia is not uncommon. However, stanford B dissection into a pre-existing abdominal aortic aneurysm resulting in bilateral lower limb ischaemia has not been reported in the literature. This patient underwent unsuccessful revascularisation of the lower limbs with an axillo-bifemoral bypass procedure.
Collapse
|
100
|
Patel K, Lindenbaum L, Plambeck CJ, Marla R, Nicolosi AC, Pagel PS. To flow or not to flow: that is the question in this chronic aortic dissection. J Cardiothorac Vasc Anesth 2008; 22:788-9. [PMID: 18922445 DOI: 10.1053/j.jvca.2007.12.017] [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: 11/18/2007] [Indexed: 11/11/2022]
Affiliation(s)
- Kishan Patel
- Department of Anesthesiology, Medical College of Wisconsin, Milwaukee, WI, USA
| | | | | | | | | | | |
Collapse
|