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Huang CC, Huang WM, Jhou ZY, Chen JH, Chen ST, Lin HC, Huang CY, Chen CH, Luo CB, Chang FC. Angioplasty and stenting for symptomatic stenosis of the left subclavian artery complicated with aortic dissection. J Chin Med Assoc 2021; 84:273-279. [PMID: 33496512 DOI: 10.1097/jcma.0000000000000492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Aortic dissection is a rare but severe complication of percutaneous transluminal angioplasty and stenting (PTAS) for stenosis of the subclavian artery (SA). This retrospective study was designed to evaluate the risk factors and outcomes of patients with severe stenosis of the SA who underwent PTAS complicated by aortic dissection. METHODS Between 1999 and 2018, 169 cases of severe symptomatic stenosis of the SA underwent PTAS at our institute. Of them, six cases complicated by aortic dissection were included in this study. We evaluated the demographic features, technical factors of PTAS, and clinical outcomes in these six patients. RESULTS Aortic dissection occurred in 5.3% (6/113) of all left SA stenting cases but in none of the right SA stenting cases. All patients had hypertension and a high severity of SA stenosis (85.0 ± 13.0%, 60%-95%). Five of the six patients received balloon-expandable stents (83.3%). All patients had spontaneous resolution of the aortic dissection with conservative treatment. In a 63.33 ± 33.07 (7-118) month follow-up, five of the six patients (83.3%) had long-term symptom relief and stent patency. CONCLUSION Aortic dissection occurred in patients who underwent PTAS for severe stenosis of the left SA, mainly with balloon-expandable stents. We suggest using self-expandable stents and angioplasty with an undersized balloon during PTAS for severe stenosis of the left proximal SA to prevent aortic dissection.
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Affiliation(s)
- Chun-Chao Huang
- Department of Radiology, MacKay Memorial Hospital, Taipei, Taiwan, ROC
- Department of Medicine, MacKay Medical College, New Taipei City, Taiwan, ROC
| | - Wei-Ming Huang
- Department of Radiology, MacKay Memorial Hospital, Taipei, Taiwan, ROC
- Department of Medicine, MacKay Medical College, New Taipei City, Taiwan, ROC
- Mackay Junior College of Medicine, Nursing, and Management, Taipei, Taiwan, ROC
| | - Zong-Yi Jhou
- Department of Radiology, MacKay Memorial Hospital, Taipei, Taiwan, ROC
- Department of Medicine, MacKay Medical College, New Taipei City, Taiwan, ROC
- Mackay Junior College of Medicine, Nursing, and Management, Taipei, Taiwan, ROC
| | - Jung-Hsuan Chen
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Shu-Ting Chen
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Hui-Chen Lin
- Department of Radiology, Sinying Hospital, Ministry of Health and Welfare, Tainan, Taiwan, ROC
| | - Chung-Yao Huang
- Department of Radiology, MacKay Memorial Hospital, Taipei, Taiwan, ROC
- Department of Medicine, MacKay Medical College, New Taipei City, Taiwan, ROC
- Mackay Junior College of Medicine, Nursing, and Management, Taipei, Taiwan, ROC
| | - Chia-Hung Chen
- Department of Radiology, MacKay Memorial Hospital, Taipei, Taiwan, ROC
- Department of Medicine, MacKay Medical College, New Taipei City, Taiwan, ROC
- Mackay Junior College of Medicine, Nursing, and Management, Taipei, Taiwan, ROC
| | - Chao-Bao Luo
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Feng-Chi Chang
- Mackay Junior College of Medicine, Nursing, and Management, Taipei, Taiwan, ROC
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
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Ram H, Dwarakanath S, Green AE, Steyn J, Hessel EA. Iatrogenic Aortic Dissection Associated With Cardiac Surgery: A Narrative Review. J Cardiothorac Vasc Anesth 2020; 35:3050-3066. [PMID: 33008721 DOI: 10.1053/j.jvca.2020.07.084] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 07/23/2020] [Accepted: 07/30/2020] [Indexed: 01/16/2023]
Abstract
Iatrogenic aortic dissection (iAD) is a relatively rare but a life-threatening complication associated with cardiac surgery. All members of the team caring for cardiac surgical patients (surgeons, perfusionists, and anesthesiologists) must be familiar with this complication to minimize its incidence and improve outcome. The present narrative review focuses on iAD occurring intraoperatively and during the early postoperative period (within 1 month) of cardiac surgery. The review also addresses iAD that occurs late (beyond 1 month) after cardiac surgery and iAD associated with other procedures. iAD occurs in about 0.06% of cases when the ascending aorta is the site of arterial cannulation, in about 0.6% when the femoral or iliac arteries are used, and in about 0.5% when the axillary or subclavian arteries are used. Mortality is estimated to be 30% but is more than double if not recognized until the postoperative period. Site of origin of dissection is most commonly the arterial inflow cannula (∼33%). Other common sites are the aortic cross-clamp or partial occlusion clamp (∼29%) and the proximal saphenous vein anastomosis site (14%). Sixty percent of cases occur during coronary artery bypass graft (CABG) surgery and 17% during aortic valve surgery with or without CABG. iAD may be somewhat less common in off-pump versus on-pump CABG but is still not very rare. Risk factors, presentation, diagnosis, and management are reviewed in detail as is the key role of the use of echocardiography in the early diagnosis of iAD and for guiding its management.
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Affiliation(s)
- Harish Ram
- Department of Anesthesiology, University of Kentucky, Lexington, KY
| | | | - Ashley E Green
- Department of Anesthesiology, University of Kentucky, Lexington, KY
| | - Johannes Steyn
- Department of Anesthesiology, University of Kentucky, Lexington, KY
| | - Eugene A Hessel
- Department of Anesthesiology, University of Kentucky, Lexington, KY.
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