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Wang Y, Liu D, Ye T, Dong X, Su Y, Liang H. Management of isolated dissection of the abdominal aorta: a single-centre experience. Interact Cardiovasc Thorac Surg 2021; 31:827-833. [PMID: 33001181 DOI: 10.1093/icvts/ivaa187] [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: 05/29/2020] [Revised: 07/07/2020] [Accepted: 07/20/2020] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES Isolated abdominal aortic dissection (IAAD) is a rare disease. Currently, there is no consensus on the management of IAAD. Our goal was to report our experience with the management of IAAD. METHODS A cohort of 45 consecutive patients with IAAD was treated between January 2010 and December 2018. We reviewed the demographics, clinical features, therapeutic modalities and follow-up results. RESULTS A total of 33 patients had successful endovascular repair (EVAR) and 12 patients underwent conservative treatment initially. During a mean follow-up of 16.6 months, 2 of the patients in the EVAR group had endoleak; neither of them needed reintervention. Complete or partial thrombosis of the false lumens was seen in all patients (88% and 12%) on the latest computed tomographic angiography images, and a significant enlargement of the true lumen and regression of the false lumen and maximal abdominal aortic diameter were observed in all patients (P < 0.001). In the group receiving conservative treatment, 3 patients were lost to follow-up; 1 patient died; 2 patients had small re-entry sites, neither of which needed intervention; 1 patient had EVAR; and the others remain symptom-free. The latest computed tomographic angiography images showed that 1 patient had spontaneous healing with complete thrombosis of the false lumen, 7 patients had partial thrombosis and the diameter of the maximal abdominal aortic and false lumen remained stable or was less decreased. CONCLUSIONS For patients with IAAD, close surveillance is necessary. In addition, EVAR is an effective therapeutic method with a high technical success rate and low complication rate for carefully selected patients.
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Affiliation(s)
- Yingliang Wang
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Hubei Key Laboratory of Molecular Imaging, Wuhan, China
| | - Dehan Liu
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Hubei Key Laboratory of Molecular Imaging, Wuhan, China
| | - Tianhe Ye
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Hubei Key Laboratory of Molecular Imaging, Wuhan, China
| | - Xiangjun Dong
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Hubei Key Laboratory of Molecular Imaging, Wuhan, China
| | - Yangbo Su
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Hubei Key Laboratory of Molecular Imaging, Wuhan, China
| | - Huimin Liang
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Hubei Key Laboratory of Molecular Imaging, Wuhan, China
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Alhaizaey A, Azazy A, Khalil E, Joudat M, Alhazmi B. Endovascular treatment for spontaneous supraceliac isolated abdominal aortic dissection is a fabulous option. (Case report). Int J Surg Case Rep 2020; 76:227-230. [PMID: 33049648 PMCID: PMC7559559 DOI: 10.1016/j.ijscr.2020.09.119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 09/16/2020] [Accepted: 09/16/2020] [Indexed: 12/02/2022] Open
Abstract
Aortic dissection originates from isolated tear in the abdominal aorta is rare but potentially life or limb-threatening condition particularly if misdiagnosed. It may have a number of clinical presentations with potentially serious adverse effects and should be considered in the differential diagnosis of any patient with an acute onset of abdominal pain radiating to the back and the buttocks together with presence or absence of a pulsatile abdominal mass, signs of limb ischemia, or discernible risk factors. Surgical and endovascular treatments are two valid options for these cases according to their clinical and anatomical considerations with acceptable results. We present a quite unusual case of a spontaneous supraceliac isolated abdominal aortic dissection with contained peri-aortic hematoma and manifesting as acute persistent abdominal pain. Better illustration of the natural history of this ill-defined pathology is needed to understand and improve patient care.
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Affiliation(s)
- Abdullah Alhaizaey
- Division of Vascular Surgery, Aseer Central Hospital-King Khalid University, Abha, Saudi Arabia.
| | - Ahmed Azazy
- Division of Vascular Surgery, Armed Forces Hospital, Southern Region, Aseer, Saudi Arabia
| | - Ehab Khalil
- Division of Vascular Surgery, Armed Forces Hospital, Southern Region, Aseer, Saudi Arabia
| | - Mohammed Joudat
- Division of Vascular Surgery, Armed Forces Hospital, Southern Region, Aseer, Saudi Arabia
| | - Barrag Alhazmi
- General Surgery Department, King Fahad Central Hospital, Jazan, Saudi Arabia
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An Off-Label Use of a Unibody Aortic Stent-Graft System for the Treatment of Infrarenal Abdominal Aortic Dissections. Case Rep Vasc Med 2019; 2019:6853135. [PMID: 31093417 PMCID: PMC6476008 DOI: 10.1155/2019/6853135] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Accepted: 03/24/2019] [Indexed: 11/17/2022] Open
Abstract
Infrarenal abdominal aortic dissections (IAAD) are exceedingly rare, accounting for 1-4% of all aortic dissections. The evidence is scarce on how to best manage IAAD when they become symptomatic. Two main interventional approaches exist, open surgery and the endovascular approach. Conventional stent-graft systems make it difficult to treat nonaneurysmal aortic disease due to limb competition in a narrow distal aorta. Thus, we present a novel use of the Endologix Anatomical Fixation 2 (AFX2) Abdominal Aortic Aneurysm (AAA) endograft system for the treatment of four patients with IAAD. We also highlight an individual case study that was treated with an alternative endovascular approach and the complications that followed. This was to highlight and compare our successful experience with Endologix AFX2 AAA endograft system. There were multiple benefits for choosing this stent-graft; however the main advantage is its suitability in the narrow distal aorta. Our aim was to highlight an alternative endovascular approach for the successful treatment of a rare, challenging, and potentially fatal pathology.
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Zhang W, Shi Z, Fu W, Chen B, Xu X, Guo D. Morphologic characteristics and endovascular treatment of primary infrarenal aortic dissections. J Vasc Surg 2017; 67:1380-1388.e1. [PMID: 28822662 DOI: 10.1016/j.jvs.2017.05.125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2017] [Accepted: 05/18/2017] [Indexed: 11/26/2022]
Abstract
OBJECTIVE We report the morphologic characteristics and endovascular treatment of primary infrarenal aortic dissections (PIRADs). METHODS A retrospective study was conducted with 38 consecutive PIRAD patients between January 2010 and May 2016 in our vascular center. Patient demographics, morphologic characteristics, endovascular modalities, and periprocedural and follow-up outcomes were recorded. Patients with symptomatic PIRADs or asymptomatic PIRADs of a maximum diameter >30 mm were indicated for endovascular aneurysm repair (EVAR). We proposed a morphologic categorization of PIRADs into two types (I and II) according to the location of the entry tears and an endovascular strategy for treating type I PIRADs with tubular stent grafts (SGs) and type II PIRADs with bifurcated SGs. RESULTS According to the categorization, the study recruited 13 patients with type I and 25 patients with type II PIRADs. The patients were predominantly men, with an average age of 60.8 ± 15.2 years. Type I PIRADs usually had larger true lumens (22.6 ± 6.3 vs 13.6 ± 4.0 mm; P = .002) and relatively smaller false lumens (8.4 ± 2.3 vs 19.9 ± 16.1 mm; P = .012). Type II PIRADs had more entry tears (2.2 ± 0.6 vs 1.7 ± 0.6; P = .024) and longer dissections (109.4 ± 38.8 vs 73.9 ± 39.0 mm; P = .011). All patients underwent EVAR, with 19 tubular and 22 bifurcated SGs. One patient died during the hospital stay. The technical success rate was 94.8% (36/38), and the clinical success rate was 97.4% (37/38). During follow-up of 36 patients for 28.8 ± 17.7 months, 2 patients with type II PIRADs developed left iliac extension occlusion at 3 and 6 months after EVAR, and only 1 patient underwent reintervention. All patients survived throughout the follow-up. No endoleak or aortic enlargement was observed. Computed tomography angiography demonstrated a patent infrarenal aorta with completely thrombosed false lumen in all PIRAD patients (36/36 [100.0%]). In both types of PIRAD, EVAR yielded a significant decrease in the maximum diameter of the infrarenal aorta, with a significant increase in the true lumen size and a significant decrease in the false lumen size (P < .05). CONCLUSIONS The morphologic categorization of PIRADs based on the location of the entry tears appeared to be feasible. The endovascular strategy was safe and effective, with high rates of technical success and clinical success and favorable follow-up outcomes.
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Affiliation(s)
- Wan Zhang
- Department of Vascular Surgery, Zhongshan Hospital, Affiliated with Fudan University, Shanghai, China
| | - Zhenyu Shi
- Department of Vascular Surgery, Zhongshan Hospital, Affiliated with Fudan University, Shanghai, China
| | - Weiguo Fu
- Department of Vascular Surgery, Zhongshan Hospital, Affiliated with Fudan University, Shanghai, China.
| | - Bin Chen
- Department of Vascular Surgery, Zhongshan Hospital, Affiliated with Fudan University, Shanghai, China
| | - Xin Xu
- Department of Vascular Surgery, Zhongshan Hospital, Affiliated with Fudan University, Shanghai, China
| | - Daqiao Guo
- Department of Vascular Surgery, Zhongshan Hospital, Affiliated with Fudan University, Shanghai, China
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Zhu QQ, Li DL, Lai MC, Chen XD, Jin W, Zhang HK, Li M. Endovascular treatment of isolated abdominal aortic dissection and postoperative aortic remodeling. J Vasc Surg 2015; 61:1424-31. [DOI: 10.1016/j.jvs.2015.01.027] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2014] [Accepted: 01/13/2015] [Indexed: 11/25/2022]
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Handa N, Nishina T, Nishio I, Asano M, Noda K, Ueno Y. Endovascular Stent-Graft Repair for Spontaneous Dissection of Infra-Renal Abdominal Aorta. Ann Vasc Surg 2010; 24:955.e1-4. [DOI: 10.1016/j.avsg.2010.03.033] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2009] [Revised: 02/20/2010] [Accepted: 03/21/2010] [Indexed: 10/19/2022]
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