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Warm TD, Gosslau Y, Scheurig-Muenkler C, Hyhlik-Duerr A. Two-year follow-up after treatment of an aortic transection in the presence of an aberrant right subclavian artery. Vascular 2024; 32:292-295. [PMID: 36384358 DOI: 10.1177/17085381221135704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2024]
Abstract
OBJECTIVES An aberrant right subclavian artery (ARSA) is one of the most common anatomic variants of the aortic arch. The combination of an ARSA and a transection is naturally rare. METHODS This case report describes the treatment of a transection in the presence of an ARSA and the follow-up of two years. RESULTS We successfully treated the contained rupture with a stentgraft. Both subclavian arteries had to be covered in the emergency setting. At the two-year follow-up, the patient did not suffer from any neurological impairment. CONCLUSIONS In emergency settings, primary cover of both subclavian arteries with a stentgraft can be performed in individual cases after risk assessment. Severe complications such as development of upper limb ischaemia, ASAS or reduced perfusion of the posterior cerebral circulation should be considered in treatment planning.
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Affiliation(s)
- Tobias D Warm
- Vascular Surgery, University of Augsburg, Augsburg, Germany
| | - Yvonne Gosslau
- Vascular Surgery, University of Augsburg, Augsburg, Germany
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2
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Ando M, Kise Y, Kuniyoshi Y, Higa S, Nagano T, Furukawa K. Usefulness of Motor Evoked Potential Measurement and Analysis of Risk Factors for Spinal Cord Ischaemia from 300 Cases of Thoracic Endovascular Aortic Repair. Eur J Vasc Endovasc Surg 2024:S1078-5884(24)00259-4. [PMID: 38499146 DOI: 10.1016/j.ejvs.2024.03.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 02/22/2024] [Accepted: 03/15/2024] [Indexed: 03/20/2024]
Abstract
OBJECTIVE This study investigated the usefulness of motor evoked potentials (MEPs) for intra-operative monitoring to detect the risk of spinal cord ischaemia (SCI) during thoracic endovascular aortic repair (TEVAR). Risk factors for SCI in TEVAR were also analysed. METHODS Among 330 TEVARs performed from February 2009 to October 2018, 300 patients underwent intra-operative MEP monitoring. SCI risk groups were extracted based on MEP amplitude changes using a cutoff value of 50%. When the amplitude decreased to < 50% of the pre-operative value, intra-operative mean arterial pressure (MAP) was increased by about 20 mmHg using noradrenaline, whereas MAP was usually controlled to about 80 mmHg during surgery. Other efforts were also made to increase MEP amplitude by increasing cardiac output, correcting anaemia, and finishing the surgery promptly. Based on MEP amplitude data, SCI risk groups were extracted and risk factors for SCI in TEVAR were analysed. RESULTS A total of 283 non-SCI risk patients and 17 SCI risk patients by MEP monitoring were extracted; only 1.0% developed immediate paraplegia and none developed delayed paraplegia. Bivariable analysis showed significant differences in chronic kidney disease, haemodialysis, artery of Adamkiewicz closure, and stent graft (SG) covered length ≥ 8 vertebral bodies. Logistic regression analysis showed hyperlipidaemia (odds ratio [OR] 3.55, 95% confidence interval [CI] 1.08 - 11.67; p = .037), SG covered length ≥ 8 vertebral bodies (OR 1.35, 95% CI 1.02 - 1.78; p = .034), and haemodialysis (OR 27.78, 95% CI 6.02 - 128.22; p < .001) were the most influential risk factors for SCI in TEVAR. CONCLUSION MEPs might be a useful monitoring tool to predict SCI in TEVAR. In addition, hyperlipidaemia, SG covered length ≥ 8 vertebral bodies, and haemodialysis represent key risk factors for SCI during TEVAR.
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Affiliation(s)
- Mizuki Ando
- Department of Thoracic and Cardiovascular Surgery, University of the Ryukyus, Nishihara, Okinawa, Japan.
| | - Yuya Kise
- Department of Thoracic and Cardiovascular Surgery, University of the Ryukyus, Nishihara, Okinawa, Japan
| | - Yukio Kuniyoshi
- Department of Cardiovascular Surgery, Urasoe General Hospital, Urasoe, Okinawa, Japan
| | - Shotaro Higa
- Department of Thoracic and Cardiovascular Surgery, University of the Ryukyus, Nishihara, Okinawa, Japan
| | - Takaaki Nagano
- Department of Thoracic and Cardiovascular Surgery, University of the Ryukyus, Nishihara, Okinawa, Japan
| | - Kojiro Furukawa
- Department of Thoracic and Cardiovascular Surgery, University of the Ryukyus, Nishihara, Okinawa, Japan
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Xie L, Wu H, He Q, Shi W, Zhang J, Xiao X, Yu T. A slow-releasing donor of hydrogen sulfide inhibits neuronal cell death via anti-PANoptosis in rats with spinal cord ischemia‒reperfusion injury. Cell Commun Signal 2024; 22:33. [PMID: 38217003 PMCID: PMC10785475 DOI: 10.1186/s12964-023-01457-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Accepted: 12/23/2023] [Indexed: 01/14/2024] Open
Abstract
BACKGROUND Spinal cord ischemia‒reperfusion injury (SCIRI) can lead to paraplegia, which leads to permanent motor function loss. It is a disastrous complication of surgery and causes tremendous socioeconomic burden. However, effective treatments for SCIRI are still lacking. PANoptosis consists of three kinds of programmed cell death, pyroptosis, apoptosis, and necroptosis, and may contribute to ischemia‒reperfusion-induced neuron death. Previous studies have demonstrated that hydrogen sulfide (H2S) exerts a neuroprotective effect in many neurodegenerative diseases. However, whether H2S is anti-PANoptosis and neuroprotective in the progression of acute SCIRI remains unclear. Thus, in this study we aimed to explore the role of H2S in SCIRI and its underlying mechanisms. METHODS Measurements of lower limb function, neuronal activity, microglia/macrophage function histopathological examinations, and biochemical levels were performed to examine the efficacy of H2S and to further demonstrate the mechanism and treatment of SCIRI. RESULTS The results showed that GYY4137 (a slow-releasing H2S donor) treatment attenuated the loss of Nissl bodies after SCIRI and improved the BBB score. Additionally, the number of TUNEL-positive and cleaved caspase-3-positive cells was decreased, and the upregulation of expression of cleaved caspase-8, cleaved caspase-3, Bax, and Bad and downregulation of Bcl-2 expression were reversed after GYY4137 administration. Meanwhile, both the expression and activation of p-MLKL, p-RIP1, and p-RIP3, along with the number of PI-positive and RIP3-positive neurons, were decreased in GYY4137-treated rats. Furthermore, GYY4137 administration reduced the expression of NLRP3, cleaved caspase-1 and cleaved GSDMD, decreased the colocalization NeuN/NLRP3 and Iba1/interleukin-1β-expressing cells, and inhibited proinflammatory factors and microglia/macrophage polarization. CONCLUSIONS H2S ameliorated spinal cord neuron loss, prevented motor dysfunction after SCIRI, and exerted a neuroprotective effect via the inhibition of PANoptosis and overactivated microglia-mediated neuroinflammation in SCIRI.
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Affiliation(s)
- Lei Xie
- Department of Orthopedic Surgery, Qingdao Municipal Hospital, Qingdao University, Qingdao, China
- Institute of Sports Medicine and Health, Qingdao University, Qingdao, China
| | - Hang Wu
- Institute of Sports Medicine and Health, Qingdao University, Qingdao, China
- Department of Orthopedics, The Affiliated Hospital of Qingdao University, Qingdao University, Qingdao, China
| | - Qiuping He
- Department of Orthopedic Surgery, Qingdao Municipal Hospital, Qingdao University, Qingdao, China
- Institute of Sports Medicine and Health, Qingdao University, Qingdao, China
| | - Weipeng Shi
- Institute of Sports Medicine and Health, Qingdao University, Qingdao, China
- Department of Orthopedics, The Affiliated Hospital of Qingdao University, Qingdao University, Qingdao, China
| | - Jing Zhang
- Institute of Sports Medicine and Health, Qingdao University, Qingdao, China
- Department of Orthopedics, The Affiliated Hospital of Qingdao University, Qingdao University, Qingdao, China
| | - Xiao Xiao
- Central Laboratories, Qingdao Municipal Hospital, University of Health and Rehabilitation Sciences, Qingdao, China.
| | - Tengbo Yu
- Department of Orthopedic Surgery, Qingdao Municipal Hospital, University of Health and Rehabilitation Sciences, Qingdao, China.
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4
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Ogino H, Iida O, Akutsu K, Chiba Y, Hayashi H, Ishibashi-Ueda H, Kaji S, Kato M, Komori K, Matsuda H, Minatoya K, Morisaki H, Ohki T, Saiki Y, Shigematsu K, Shiiya N, Shimizu H, Azuma N, Higami H, Ichihashi S, Iwahashi T, Kamiya K, Katsumata T, Kawaharada N, Kinoshita Y, Matsumoto T, Miyamoto S, Morisaki T, Morota T, Nanto K, Nishibe T, Okada K, Orihashi K, Tazaki J, Toma M, Tsukube T, Uchida K, Ueda T, Usui A, Yamanaka K, Yamauchi H, Yoshioka K, Kimura T, Miyata T, Okita Y, Ono M, Ueda Y. JCS/JSCVS/JATS/JSVS 2020 Guideline on Diagnosis and Treatment of Aortic Aneurysm and Aortic Dissection. Circ J 2023; 87:1410-1621. [PMID: 37661428 DOI: 10.1253/circj.cj-22-0794] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/05/2023]
Affiliation(s)
- Hitoshi Ogino
- Department of Cardiovascular Surgery, Tokyo Medical University
| | - Osamu Iida
- Cardiovascular Center, Kansai Rosai Hospital
| | - Koichi Akutsu
- Cardiovascular Medicine, Nippon Medical School Hospital
| | - Yoshiro Chiba
- Department of Cardiology, Mito Saiseikai General Hospital
| | | | | | - Shuichiro Kaji
- Department of Cardiovascular Medicine, Kansai Electric Power Hospital
| | - Masaaki Kato
- Department of Cardiovascular Surgery, Morinomiya Hospital
| | - Kimihiro Komori
- Division of Vascular and Endovascular Surgery, Department of Surgery, Nagoya University Graduate School of Medicine
| | - Hitoshi Matsuda
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center
| | - Kenji Minatoya
- Department of Cardiovascular Surgery, Graduate School of Medicine, Kyoto University
| | | | - Takao Ohki
- Division of Vascular Surgery, Department of Surgery, The Jikei University School of Medicine
| | - Yoshikatsu Saiki
- Division of Cardiovascular Surgery, Graduate School of Medicine, Tohoku University
| | - Kunihiro Shigematsu
- Department of Vascular Surgery, International University of Health and Welfare Mita Hospital
| | - Norihiko Shiiya
- First Department of Surgery, Hamamatsu University School of Medicine
| | | | - Nobuyoshi Azuma
- Department of Vascular Surgery, Asahikawa Medical University
| | - Hirooki Higami
- Department of Cardiology, Japanese Red Cross Otsu Hospital
| | | | - Toru Iwahashi
- Department of Cardiovascular Surgery, Tokyo Medical University
| | - Kentaro Kamiya
- Department of Cardiovascular Surgery, Tokyo Medical University
| | - Takahiro Katsumata
- Department of Thoracic and Cardiovascular Surgery, Osaka Medical College
| | - Nobuyoshi Kawaharada
- Department of Cardiovascular Surgery, Sapporo Medical University School of Medicine
| | | | - Takuya Matsumoto
- Department of Vascular Surgery, International University of Health and Welfare
| | | | - Takayuki Morisaki
- Department of General Medicine, IMSUT Hospital, the Institute of Medical Science, the University of Tokyo
| | - Tetsuro Morota
- Department of Cardiovascular Surgery, Nippon Medical School Hospital
| | | | - Toshiya Nishibe
- Department of Cardiovascular Surgery, Tokyo Medical University
| | - Kenji Okada
- Department of Surgery, Division of Cardiovascular Surgery, Kobe University Graduate School of Medicine
| | | | - Junichi Tazaki
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University
| | - Masanao Toma
- Department of Cardiology, Hyogo Prefectural Amagasaki General Medical Center
| | - Takuro Tsukube
- Department of Cardiovascular Surgery, Japanese Red Cross Kobe Hospital
| | - Keiji Uchida
- Cardiovascular Center, Yokohama City University Medical Center
| | - Tatsuo Ueda
- Department of Radiology, Nippon Medical School
| | - Akihiko Usui
- Department of Cardiac Surgery, Nagoya University Graduate School of Medicine
| | - Kazuo Yamanaka
- Cardiovascular Center, Nara Prefecture General Medical Center
| | - Haruo Yamauchi
- Department of Cardiac Surgery, The University of Tokyo Hospital
| | | | - Takeshi Kimura
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University
| | | | - Yutaka Okita
- Department of Surgery, Division of Cardiovascular Surgery, Kobe University Graduate School of Medicine
| | - Minoru Ono
- Department of Cardiac Surgery, Graduate School of Medicine, The University of Tokyo
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5
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Oberhuber A, Raddatz A, Betge S, Ploenes C, Ito W, Janosi RA, Ott C, Langheim E, Czerny M, Puls R, Maßmann A, Zeyer K, Schelzig H. Interdisciplinary German clinical practice guidelines on the management of type B aortic dissection. GEFASSCHIRURGIE 2023; 28:1-28. [PMCID: PMC10123596 DOI: 10.1007/s00772-023-00995-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/14/2023] [Indexed: 08/13/2023]
Affiliation(s)
- A. Oberhuber
- German Society of Vascular Surgery and Vascular Medicine (DGG); Department of Vascular and Endovascular Surgery, University Hospital of Münster, Münster, Germany
| | - A. Raddatz
- German Society of Anaesthesiology and Intensive Care Medicine (DGAI); Department of Anaesthesiology, Critical Care and Pain Medicine, Saarland University Hospital, Homburg, Germany
| | - S. Betge
- German Society of Angiology and Vascular Medicine (DGG); Department of Internal Medicine and Angiology, Helios Hospital Salzgitter, Salzgitter, Germany
| | - C. Ploenes
- German Society of Geriatrics (DGG); Department of Angiology, Schön Klinik Düsseldorf, Düsseldorf, Germany
| | - W. Ito
- German Society of Internal Medicine (GSIM) (DGIM); cardiovascular center Oberallgäu Kempten, Hospital Kempten, Kempten, Germany
| | - R. A. Janosi
- German Cardiac Society (DGK); Department of Cardiology and Angiology, University Hospital Essen, Essen, Germany
| | - C. Ott
- German Society of Nephrology (DGfN); Department of Nephrology and Hypertension, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
- Department of Nephrology and Hypertension, Paracelsus Medical University, Nürnberg, Germany
| | - E. Langheim
- German Society of prevention and rehabilitation of cardiovascular diseaese (DGPR), Reha Center Seehof, Teltow, Germany
| | - M. Czerny
- German Society of Thoracic and Cardiovascular Surgery (DGTHG), Department University Heart Center Freiburg – Bad Krozingen, Freiburg, Germany
- Albert Ludwigs University Freiburg, Freiburg, Germany
| | - R. Puls
- German Radiologic Society (DRG); Institute of Diagnostic an Interventional Radiology and Neuroradiology, Helios Klinikum Erfurt, Erfurt, Germany
| | - A. Maßmann
- German Society of Interventional Radiology (DeGIR); Department of Diagnostic an Interventional Radiology, Saarland University Hospital, Homburg, Germany
| | - K. Zeyer
- Marfanhilfe e. V., Weiden, Germany
| | - H. Schelzig
- German Society of Surgery (DGCH); Department of Vascular and Endovascular Surgery, University Hospital of Düsseldorf, Düsseldorf, Germany
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6
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Zhao Y, Chen Y, Wang Z, Xu C, Qiao S, Liu T, Qi K, Tong D, Li C. Bone Marrow Mesenchymal Stem Cell Exosome Attenuates Inflammasome-Related Pyroptosis via Delivering circ_003564 to Improve the Recovery of Spinal Cord Injury. Mol Neurobiol 2022; 59:6771-6789. [PMID: 36038697 DOI: 10.1007/s12035-022-03006-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 08/16/2022] [Indexed: 10/15/2022]
Abstract
Bone marrow mesenchymal stem cell (BMSC) is previously reported to present a certain effect on treating spinal cord injury (SCI), while the underlying mechanism is largely uncovered. Therefore, the current study aimed to investigate the involvement of exosome-delivered circRNA profile in the BMSC's effect on pyroptosis for SCI treatment. H2O2 treated rat primary neurons were cultured with normal medium, BMSC, BMSC plus GW4869, and BMSC-derived exosome, respectively, then inflammasome-related pyroptosis markers, and circRNA profiles were detected. Subsequently, circ_003564-knockdown BMSC exosome was transfected into H2O2 treated rat primary neurons and NGF-stimulated PC-12 cells. Furthermore, in vivo validation was conducted. BMSC and BMSC-derived exosome both decreased inflammasome-related pyroptosis markers including cleaved caspase-1, GSDMD, NLRP3, IL-1β, and IL-18 in H2O2-treated neurons, while exosome-free BMSC (BMSC plus GW4869) did not obviously reduce these factors. Microarray assay revealed that BMSC (vs. exosome-free BMSC) and BMSC-derived exosome (vs. normal medium) greatly regulated circRNA profiles, which were enriched in neuroinflammation pathways (such as neurotrophin, apoptosis, and TNF). Among three functional candidate circRNAs (circ_015525, circ_008876, and circ_003564), circ_003564 was most effective to regulate inflammasome-related pyroptosis. Interestingly, circ_003564-knockdown BMSC exosome showed higher expression of inflammasome-related pyroptosis markers compared to negative-control-knockdown BMSC exosome in H2O2 treated primary neurons/NGF-stimulated PC-12 cells. In vivo, BMSC exosome improved the function recovery and decreased tissue injury and inflammasome-related pyroptosis in SCI rats, whose effect was attenuated by circ_003564 knockdown transfection. BMSC exosome attenuates inflammasome-related pyroptosis via delivering circ_003564, contributing to its treatment efficacy for SCI.
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Affiliation(s)
- Yanyin Zhao
- Department of Neurology, Huashan Hospital, Fudan University, Shanghai, China
| | - Yu Chen
- Department of Orthopedics, Huashan Hospital, Fudan University, Shanghai, China
| | - Zhiwei Wang
- Department of Orthopedics, Changhai Hospital, Naval Medical University, No. 168 Changhai Road, Shanghai, 200433, China
| | - Changli Xu
- Department of Orthopedics, Changhai Hospital, Naval Medical University, No. 168 Changhai Road, Shanghai, 200433, China
| | - Suchi Qiao
- Department of Orthopedics, Changzheng Hospital, Naval Medical University, Shanghai, China
| | - Tianze Liu
- Department of Orthopedics, Changhai Hospital, Naval Medical University, No. 168 Changhai Road, Shanghai, 200433, China
| | - Ke Qi
- Department of Orthopedics, Changhai Hospital, Naval Medical University, No. 168 Changhai Road, Shanghai, 200433, China
| | - Dake Tong
- Shanghai Key Laboratory of Orthopedic Implants, Department of Orthopedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, No. 639 Zhizaoju Road, Shanghai, 200011, China.
| | - Cheng Li
- Department of Orthopedics, Changhai Hospital, Naval Medical University, No. 168 Changhai Road, Shanghai, 200433, China.
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7
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Sule J, Chua CR, Teo C, Choong A, Sazzad F, Kofidis T, Sorokin V. Hybrid type II and frozen elephant trunk in acute Stanford type A aortic dissections. SCAND CARDIOVASC J 2022; 56:91-99. [PMID: 35546567 DOI: 10.1080/14017431.2022.2074095] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Objectives. Composite frozen elephant trunk is an increasingly popular solution for complex aortic pathologies. This review aims to compare outcomes of zone 0 type II hybrid (hybrid II) with the composite frozen elephant trunk (FET) technique in managing acute Stanford type A aortic dissections. Methods. PubMed and Embase were systematically searched using PRISMA protocol. 11 relevant studies describing the outcomes of hybrid II arch repair and FET techniques in patients with type A aortic dissection were included in the meta-analysis. The study focused on early post-operative 30-day outcomes analysing mortality, stroke, spinal cord injury, renal impairment requiring dialysis, bleeding and lung infection. Results. 1305 patients were included in the analysis - 343 receiving hybrid II repair and 962 treated with the FET. Meta-analysis of proportions showed Hybrid II was associated with less early mortality [5.0 (CI 3.1-7.8) vs 8.1 (CI 6.5-10.0) %], stroke [2.3 (CI 1.1-4.6) vs 7.0 (CI 5.5-8.8) %], spinal cord injury [2.0 (CI 0.9-4.3) vs 3.8 (CI 2.8-5.3) %], renal impairment requiring dialysis [7.9 (CI 5.5-11.2) vs 11.8 (CI 9.8-14.0) %], reoperation for bleeding [3.9 (CI 1.8-8.4) vs 10.6 (CI 8.1-13.8) %] and lung infection [14.8 (CI 10.8-20.0) vs 20.7 (CI 16.9-25.1) %]. Conclusion. Hybrid II should be considered in favour of FET technique in acute Stanford type A dissection patients who are at higher risk due to age and comorbidities.
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Affiliation(s)
- Jai Sule
- Department of Cardiac, Thoracic and Vascular Surgery, National University Heart Centre, National University Health System, Singapore
| | - Cher Rui Chua
- Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Caven Teo
- Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Andrew Choong
- Department of Cardiac, Thoracic and Vascular Surgery, National University Heart Centre, National University Health System, Singapore.,Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Faizus Sazzad
- Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Theo Kofidis
- Department of Cardiac, Thoracic and Vascular Surgery, National University Heart Centre, National University Health System, Singapore.,Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Vitaly Sorokin
- Department of Cardiac, Thoracic and Vascular Surgery, National University Heart Centre, National University Health System, Singapore.,Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
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8
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Liu X, Ji W, Tian M, Chen H, Li C, Zhang L, Yang Y, Wang J, Ji M, Yang C, Zhu E, Cong L, Zhang X, Zhou X, Liu H, Wang J, Tan J, Zhang J. The short-term safety and effectiveness of a new distal perforating stent graft in Type B aortic dissection: a retrospective study. BMC Cardiovasc Disord 2021; 21:457. [PMID: 34548009 PMCID: PMC8456669 DOI: 10.1186/s12872-021-02270-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Accepted: 09/14/2021] [Indexed: 11/22/2022] Open
Abstract
Background Spinal artery ischemia (SCI) events can result from over coverage of the descending thoracic aorta with a coated stent during Thoracic Endovascular Aortic Repair (TEVAR). The aim of this study was to determine whether a new distal perforating stent could reduce the incidence of spinal cord ischemia while remodeling the true lumen. Methods TBAD patients treated with Talos stent in the vascular surgery Department of Yan 'an Hospital affiliated to Kunming Medical University between December 2017 and October 2019 were retrospectively analyzed to investigate the short-term safety and effectiveness of Talos stent. Results A total of the 20 patients, including 14 males and 6 females, with an average age of 52.65 ± 8.98 years (range 37–68 years), were included in the analysis. Stent-grafts were successfully implanted in all patients under local anesthesia, with a technical success rate of 100%. The average operation time was 50.75 ± 13.01 min. A total of 2 cases (10%) presented chest pain associated with intercostal artery ischemia that was relieved on the 3rd and 5th postoperative day, respectively. Postoperative mean follow-up was 16.15 ± 3.99 months. No paraplegia or other complications occurred. And stenting did not induce new tears. No migration, deformation, or fracture of the stents occurred. There was a significant difference in the remolding of the true lumen preoperatively and at 12 months postoperatively (P < 0.05). Conclusions Talos stent has achieved satisfactory clinical treatment results in short term.
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Affiliation(s)
- Xunqiang Liu
- Vascular Intervention Department, Yan'an Hospital Affiliated to Kunming Medical University, Kunming, China
| | - Wenkai Ji
- The First School of Clinical Medicine, Yunnan University of Chinese Medicine, Yunnan, China
| | - Min Tian
- Vascular Intervention Department, Yan'an Hospital Affiliated to Kunming Medical University, Kunming, China
| | - Huanjun Chen
- Vascular Intervention Department, Yan'an Hospital Affiliated to Kunming Medical University, Kunming, China
| | - Cuihong Li
- Pharmacy Department, Yan'an Hospital Affiliated to Kunming Medical University, Kunming, China.
| | - Liqiong Zhang
- Ultrasonic Department, Yan'an Hospital Affiliated to Kunming Medical University, Kunming, China.
| | - Ying Yang
- Vascular Intervention Department, Yan'an Hospital Affiliated to Kunming Medical University, Kunming, China
| | - Jifeng Wang
- Vascular Intervention Department, Yan'an Hospital Affiliated to Kunming Medical University, Kunming, China
| | - Min Ji
- Vascular Intervention Department, Yan'an Hospital Affiliated to Kunming Medical University, Kunming, China
| | - Chunxin Yang
- Vascular Intervention Department, Yan'an Hospital Affiliated to Kunming Medical University, Kunming, China
| | - Enshuai Zhu
- Vascular Intervention Department, Yan'an Hospital Affiliated to Kunming Medical University, Kunming, China
| | - Lei Cong
- Vascular Intervention Department, Yan'an Hospital Affiliated to Kunming Medical University, Kunming, China
| | - Xili Zhang
- Pain Treatment Department, First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Xiaona Zhou
- Vascular Intervention Department, Yan'an Hospital Affiliated to Kunming Medical University, Kunming, China
| | - Hailong Liu
- Vascular Intervention Department, Yan'an Hospital Affiliated to Kunming Medical University, Kunming, China
| | - Jiaping Wang
- Intervention Department, The Second Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Jing Tan
- Office of Hospital Director, Yan'an Hospital Affiliated to Kunming Medical University, Kunming, China
| | - Jinhui Zhang
- Vascular Intervention Department, Yan'an Hospital Affiliated to Kunming Medical University, Kunming, China.
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9
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Takebayashi K, Shiwa T, Ishikawa T, Taira T, Kawamata T. Spinal cord infarction six months after thoracic endovascular aortic repair- A case report. Heliyon 2020; 6:e04869. [PMID: 32964161 PMCID: PMC7490530 DOI: 10.1016/j.heliyon.2020.e04869] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 06/02/2020] [Accepted: 09/04/2020] [Indexed: 11/24/2022] Open
Abstract
Spinal cord infarction is reported to account for less than 1% of all strokes and is a relatively rare disease. In recent years, thoracic endovascular aortic repair (TEVAR) has become a common treatment for aortic aneurysms, and spinal cord ischemia is one of its complications. Most cases occur in the perioperative period; however, a few cases have been reported in the chronic stage. Here, we report a case of spinal cord infarction, 6 months after TEVAR. A 77-year-old man experienced sudden onset paraparesis following dumbbell exercises and defecation. He had a history of an infectious thoracoabdominal aortic aneurysm treated by TEVAR 6 months prior. Paralysis and disturbance of the thermal pain and tactile sensations of the lower limbs were observed, but proprioception and deep sensation were preserved. Computed tomography (CT) showed no evidence of intraspinal hemorrhage, new aortic dissection, or endoleak around the aortic stent placed from Th11 to L3. Magnetic resonance imaging (MRI) showed intramedullary hyperintensity from Th11 to the conus 2 days after onset. Anticoagulant therapy and rehabilitation were performed, and the lower-limb muscle strength gradually improved. After aortic stenting, particularly including the level of the Adamkiewicz artery, the risk of spinal cord ischemia must be monitored, because spinal circulation depends on collateral circulation.
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Safety and efficacy of the percutaneous thoracic endovascular repair with regional anesthesia. Gen Thorac Cardiovasc Surg 2020; 69:267-273. [PMID: 32725473 DOI: 10.1007/s11748-020-01452-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 07/24/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVES Thoracic endovascular aortic repair (TEVAR) is typically performed with general anesthesia (GA) and surgical cutdown (G-TEVAR). As the latest generation of TEVAR delivery systems are smaller, we introduced percutaneous TEVAR with regional anesthesia (RA) (R-TEVAR) and an arteriotomy closure device. In this study, we compare the safety and efficacy of R-TEVAR to that of the G-TEVAR. METHODS This single-center observational study included consecutive patients who underwent either G-TEVAR between January 2015 and October 2018 (33 patients) or R-TEVAR (41 patients) between January 2018 and April 2020. RA was achieved using an ultrasound-guided nerve block. RESULTS The mean outer diameter of the delivery device was significantly smaller in R-TEVAR (18.5 vs. 22.7 Fr; p < 0.01) and the time from arriving into the operating room to beginning of surgery (34.1 vs. 68.5 min; p < 0.01), procedural time (46.4 vs. 103.6 min; p < 0.01), and operating room stay time (108.3 vs. 194.6 min; p < 0.01) were significantly shorter. The mean rate of change in blood pressure was significantly lower in the R-TEVAR group (7.7% vs. 32.2%; p < 0.01). One case of spinal cord ischemia occurred in the G-TEVAR group (0% vs. 3.0%; p = 0.262) and one case of inadequate hemostasis and conversion to surgical cutdown without GA occurred in the R-TEVAR group (2.4% vs. 0%; p = 0.366). CONCLUSIONS The R-TEVAR is safe and minimally invasive. Further, RA may provide additional benefits of mean blood pressure stability and early recognition of neurologic complications.
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Malloy PC, Raghavan A, Elder T, Wright J, Wright CH, Burant C, Sajatovic M, Hoffer A. Cerebrospinal Fluid Drainage During Endovascular Aortic Aneurysm Repair: A Systematic Review of the Literature and Treatment Recommendations. Vasc Endovascular Surg 2019; 54:205-213. [DOI: 10.1177/1538574419896525] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Introduction: Spinal cord injury (SCI) is a known complication of aortic aneurysm repair. Previous reports indicate that cerebrospinal fluid drainage (CSFD) may reduce incidence of SCI during open aortic aneurysm repair but its utility in endovascular repair remains poorly understood. We performed a systematic review of the literature to examine the protocols and outcomes of CSFD in patients undergoing endovascular aortic aneurysm repair. Methods: The Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines were utilized to conduct a systematic literature review. PubMed, Scopus, Ovid, Cochrane, and EMBASE were queried for articles published since 2016 using search terms “(cerebrospinal fluid diversion OR CSF diversion OR lumbar drain OR subarachnoid drain OR spinal) AND (aortic aneurysm AND thoracic AND endovascular OR TEVAR).” Ninety-two articles were identified and screened by 2 independent reviewers, and 23 studies met criteria for full-text review after initial screening. Results: A total of 8 studies met full inclusion criteria for final analysis. Six studies reported incidence of SCI in patients with CSFD and 2 compared SCI incidence between patients with and without CSFD. Protocols for drainage most commonly included draining to a target pressure intra- and postoperatively, between 8 and 12 mm Hg. Incidence of SCI ranged from 0% to 17% in patients with CSFD, and from 0% to 50% in those without CSFD. Rates of CSFD-related complications ranged from <1% to 28%. Conclusion: There may be a protective benefit of CSFD in preventing SCI, but there remains significant variation in drain placement protocols. Significant potential bias exists in the reviewed data. Higher quality studies on the role of CSFD in endovascular aortic aneurysm repair are needed.
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Affiliation(s)
- Patrick C. Malloy
- School of Medicine, Case Western Reserve University, Cleveland, OH, USA
- Patrick C. Malloy and Alankrita Raghavan contributed equally to the content
| | - Alankrita Raghavan
- School of Medicine, Case Western Reserve University, Cleveland, OH, USA
- Patrick C. Malloy and Alankrita Raghavan contributed equally to the content
| | - Theresa Elder
- Department of Neurosurgery, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - James Wright
- School of Medicine, Case Western Reserve University, Cleveland, OH, USA
- Department of Neurosurgery, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Christina Huang Wright
- School of Medicine, Case Western Reserve University, Cleveland, OH, USA
- Department of Neurosurgery, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Christopher Burant
- Mandel School of Applied Social Sciences, Case Western Reserve University, Cleveland, OH, USA
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH, USA
| | - Martha Sajatovic
- Neurological and Behavioral Outcomes Center, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
- Department of Neurology, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
- Department of Psychiatry, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Alan Hoffer
- Department of Neurosurgery, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
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Nakamura E, Nakamura K, Furukawa K, Ishii H, Shirasaki Y, Ichiki N, Higuchi K, Sakurahara D, Hamahiro T. Left Subclavian Artery Revascularization for Delayed Paralysis after Thoracic Endovascular Aortic Repair. Ann Vasc Dis 2019; 12:233-235. [PMID: 31275481 PMCID: PMC6600088 DOI: 10.3400/avd.cr.18-00158] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Spinal cord ischemia (SCI) is a devastating complication following thoracic endovascular aortic repair (TEVAR). A man with a ruptured thoracic aortic aneurysm (TAA) was transferred to our hospital. Emergency TEVAR, with left subclavian artery (LSA) coverage, was performed for the ruptured TAA. On postoperative day two, the patient had incomplete paralysis in his legs, presumably caused by SCI. We performed LSA revascularization (LSAR) to provide blood supply to the spinal cord; his paralysis improved and almost resolved after surgery. To our knowledge, this is the first report on LSAR's efficacy for delayed paraplegia due to SCI.
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Affiliation(s)
- Eisaku Nakamura
- Division of Cardiovascular Surgery, Department of Surgery, University of Miyazaki, Miyazaki, Miyazaki, Japan
| | - Kunihide Nakamura
- Division of Cardiovascular Surgery, Department of Surgery, University of Miyazaki, Miyazaki, Miyazaki, Japan
| | - Koji Furukawa
- Division of Cardiovascular Surgery, Department of Surgery, University of Miyazaki, Miyazaki, Miyazaki, Japan
| | - Hirohito Ishii
- Division of Cardiovascular Surgery, Department of Surgery, University of Miyazaki, Miyazaki, Miyazaki, Japan
| | - Yukie Shirasaki
- Division of Cardiovascular Surgery, Department of Surgery, University of Miyazaki, Miyazaki, Miyazaki, Japan
| | - Nobuhiko Ichiki
- Division of Cardiovascular Surgery, Department of Surgery, University of Miyazaki, Miyazaki, Miyazaki, Japan
| | - Kazuhiro Higuchi
- Division of Cardiovascular Surgery, Department of Surgery, University of Miyazaki, Miyazaki, Miyazaki, Japan
| | - Daichi Sakurahara
- Division of Cardiovascular Surgery, Department of Surgery, University of Miyazaki, Miyazaki, Miyazaki, Japan
| | - Tomoka Hamahiro
- Division of Cardiovascular Surgery, Department of Surgery, University of Miyazaki, Miyazaki, Miyazaki, Japan
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13
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Janczak D, Ziomek A, Kobecki J, Malinowski M, Pormańczuk K, Chabowski M. Neurological complications after thoracic endovascular aortic repair. Does the left subclavian artery coverage without revascularization increase the risk of neurological complications in patients after thoracic endovascular aortic repair? J Cardiothorac Surg 2019; 14:5. [PMID: 30621728 PMCID: PMC6325786 DOI: 10.1186/s13019-018-0825-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Accepted: 12/26/2018] [Indexed: 01/05/2023] Open
Abstract
Introduction One of the most severe complications after TEVAR is ischemic stroke and spinal cord ischemia (SCI) resulting in severe disability. These complications can be fatal up to 30% of cases, so it is very important to define risk factors associated with the occurrence of such events. The aim of this study was to define the causes and risk factors associated with the occurrence of neurological complications in patients after TEVAR. Materials and methods We performed a retrospective analysis of 51 patients undergoing TEVAR in the Department of Vascular Surgery of Military Teaching Hospital in Wroclaw between 2014 and 2017. In 18 patients LSA coverage was managed without revascularization (35.29%), and in 33 patients LSA remained uncovered (64.71%). Results We did not find any statistically significant difference in the incidence of stroke and spinal cord ischemia in patients with covered and uncovered LSA (stroke p = 0.37, SCI p = 0.58). In the group of patients with covered and uncovered LSA, we did not find any significant differences in the incidence of additional comorbidities such as obesity, ischemic heart disease, hypertension or previous stroke. Conclusions There is no difference in stroke and SCI occurrence between patients with covered and uncovered LSA. Although there are many studies analysing the risk of such complications, there is no specific consensus regarding the treatment of LSA coverage. Randomised clinical trials on a large group of patients are still needed.
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Affiliation(s)
- Dariusz Janczak
- Department of Vascular, General and Transplantation Surgery, Faculty of Postgraduate Medical Training, Wroclaw Medical University, 213 Borowska street, 50-556, Wroclaw, Poland
| | - Agnieszka Ziomek
- Department of Vascular, General and Transplantation Surgery, Faculty of Postgraduate Medical Training, Wroclaw Medical University, 213 Borowska street, 50-556, Wroclaw, Poland.,Department of Surgery, 4th Military Teaching Hospital, 5 Weigla street, 50-981, Wroclaw, Poland
| | - Jakub Kobecki
- Department of Surgery, 4th Military Teaching Hospital, 5 Weigla street, 50-981, Wroclaw, Poland
| | - Maciej Malinowski
- Department of Vascular, General and Transplantation Surgery, Faculty of Postgraduate Medical Training, Wroclaw Medical University, 213 Borowska street, 50-556, Wroclaw, Poland
| | - Kornel Pormańczuk
- Department of Surgery, 4th Military Teaching Hospital, 5 Weigla street, 50-981, Wroclaw, Poland.,Division of Surgical Specialties, Department of Clinical Nursing, Faculty of Health Science, Wroclaw Medical University, 5 Bartla Street, 51-618, Wroclaw, Poland
| | - Mariusz Chabowski
- Department of Surgery, 4th Military Teaching Hospital, 5 Weigla street, 50-981, Wroclaw, Poland. .,Division of Surgical Specialties, Department of Clinical Nursing, Faculty of Health Science, Wroclaw Medical University, 5 Bartla Street, 51-618, Wroclaw, Poland.
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Sueda T, Takahashi S, Katayama K, Morita S, Watanabe M, Kurosaki T. The long-term outcomes of partial arch repair using the frozen elephant trunk technique for distal arch aortic aneurysm. Surg Today 2018; 48:1035-1039. [PMID: 29934686 DOI: 10.1007/s00595-018-1688-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Accepted: 06/15/2018] [Indexed: 11/27/2022]
Abstract
PURPOSE The purpose of this study was to evaluate the long-term results of partial arch repair using the frozen elephant trunk (FET) technique for distal arch aortic aneurysm and to examine the late complications. METHODS Thirty-eight patients with true distal arch aortic aneurysms were repaired with FET introduced through an incision in the proximal arch aorta. Follow-up computed tomography was performed every 6 or 12 months in 36 surviving patients. The maximum dimension of the excluded aneurysmal space was measured to determine whether the aneurysmal space had decreased or disappeared. Late complications were also evaluated during the long-term follow-up. RESULTS There was 1 hospital death (2.6%) and 1 (2.6%) case of paraplegia. There were 2 late sudden deaths (5.2%) thought to be due to aneurysm rupture and arrhythmia. Postoperative serial-computed tomography showed shrinkage of the excluded aneurysmal space in 33 of 36 patients. Late aneurysmal formation occurred in the anastomotic site in three patients. One patient underwent thoracic endovascular stent grafting 10 years after surgery, 1 patient had total arch replacement 9 years after surgery, and 1 died due to rupture. CONCLUSION Frozen elephant trunk was found to be a useful alternative for treating true distal arch aortic aneurysm. However, we must be alert for late aneurysmal formation at the incision site.
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Affiliation(s)
- Taijiro Sueda
- Department of Cardiovascular Surgery, Graduate School of Medicine, Hiroshima University, 1-2-3, Kasumi, Minami-ku, Hiroshima, 734-8551, Japan.
| | - Shinya Takahashi
- Department of Cardiovascular Surgery, Graduate School of Medicine, Hiroshima University, 1-2-3, Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Keijiro Katayama
- Department of Cardiovascular Surgery, Graduate School of Medicine, Hiroshima University, 1-2-3, Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Shohei Morita
- Department of Cardiovascular Surgery, Graduate School of Medicine, Hiroshima University, 1-2-3, Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Masazumi Watanabe
- Department of Cardiovascular Surgery, Graduate School of Medicine, Hiroshima University, 1-2-3, Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Tatsuya Kurosaki
- Department of Cardiovascular Surgery, Graduate School of Medicine, Hiroshima University, 1-2-3, Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
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