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Xu H, Li Z, Dong H, Zhang Y, Wei J, Watton PN, Guo W, Chen D, Xiong J. Hemodynamic parameters that may predict false-lumen growth in type-B aortic dissection after endovascular repair: A preliminary study on long-term multiple follow-ups. Med Eng Phys 2017; 50:12-21. [PMID: 28890304 DOI: 10.1016/j.medengphy.2017.08.011] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2016] [Revised: 08/03/2017] [Accepted: 08/21/2017] [Indexed: 01/16/2023]
Abstract
Thoracic endovascular aortic repair (TEVAR) is commonly applied in type-B aortic dissection. For patients with dissection affects descending aorta and extends downward to involve abdominal aorta and possibly iliac arteries, false lumen (FL) expansion might occur post-TEVAR. Predictions of dissection development may assist in medical decision on re-intervention or surgery. In this study, two patients are selected with similar morphological features at initial presentation but with different long-term FL development post-TEVAR (stable and enlarged FL). Patient-specific models are established for each of the follow-ups. Flow boundaries and computational validations are obtained from Doppler ultrasound velocimetry. By analyzing the hemodynamic parameters, the false-to-true luminal pressure difference (PDiff) and particle relative residence time (RRT) are found related to FL remodeling. It is found that (i) the position of the first FL flow entry is the watershed of negative-and-positive PDiff and, in long-term follow-ups, and the position of largest PDiff is consistent with that of the greatest increase of FL width; (ii) high RRT occurs at the FL proximal tip and similar magnitude of RRT is found in both stable and enlarged cases; (iii) comparing to the RRT at 7days post-TEVAR, an increase of RRT afterwards in short-term is found in the stable case while a slight decrease of this parameter is found in the enlarged case, indicating that the variation of RRT in short-term post-TEVAR might be potential to predict long-term FL remodeling.
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Affiliation(s)
- Huanming Xu
- School of Life Science, Beijing Institute of Technology, Beijing, 100081, China; Key Laboratory of Convergence Medical Engineering System and Healthcare Technology, The Ministry of Industry and Information Technology, Beijing Institute of Technology, China
| | - Zhenfeng Li
- School of Life Science, Beijing Institute of Technology, Beijing, 100081, China; Key Laboratory of Convergence Medical Engineering System and Healthcare Technology, The Ministry of Industry and Information Technology, Beijing Institute of Technology, China
| | - Huiwu Dong
- Department of Ultrasound Diagnosis, Chinese PLA General Hospital, China
| | - Yilun Zhang
- School of Life Science, Beijing Institute of Technology, Beijing, 100081, China
| | - Jianyong Wei
- School of Life Science, Beijing Institute of Technology, Beijing, 100081, China
| | - Paul N Watton
- Department of Computer Science & INSIGNEO Institute, University of Sheffield, UK; Department of Mechanical Engineering and Material Science, University of Pittsburgh, United States
| | - Wei Guo
- Department of Vascular and Endovascular Surgery, Chinese PLA General Hospital, Beijing 100853, China
| | - Duanduan Chen
- School of Life Science, Beijing Institute of Technology, Beijing, 100081, China; Key Laboratory of Convergence Medical Engineering System and Healthcare Technology, The Ministry of Industry and Information Technology, Beijing Institute of Technology, China.
| | - Jiang Xiong
- Department of Vascular and Endovascular Surgery, Chinese PLA General Hospital, Beijing 100853, China.
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Aneurysmal Degeneration in Patients with Type B Aortic Dissection. Ann Vasc Surg 2016; 36:121-126. [PMID: 27421200 DOI: 10.1016/j.avsg.2016.03.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2015] [Revised: 02/15/2016] [Accepted: 03/13/2016] [Indexed: 11/20/2022]
Abstract
BACKGROUND The optimal management of type B aortic dissection (TBAD) remains controversial in the era of endovascular therapies. This study reports the outcomes and complication rates of different treatment paradigms for TBAD. METHODS A retrospective review was undertaken of all patients with TBAD from June 2006 to June 2012. Demographics, hospital course, and follow-up visits were analyzed. Patients who underwent surgical interventions were compared to those with medical therapy. Survival rates and predictors of outcome were determined using the Kaplan-Meier method with Cox proportional hazards. RESULTS Of 261 consecutive patients who were hospitalized during this period with a confirmed thoracic dissection, 134 (51%) had TBAD. Sixty-two (46%) were women, and the mean age was 66.4 ± 14.9. Median follow-up was 22.4 (0, 184) months. Thirty-five patients underwent surgical intervention with 20 thoracic endovascular aortic repair (TEVAR) and open surgery in 15. The overall 30-day mortality was 7%, and cumulative survival rates at 1, 3, and 5 years were 85% (95% confidence interval [CI], 79-91), 68% (95% CI, 59-78), and 57% (95% CI, 47-69) with no difference between medical versus surgical groups (P = 0.8) and TEVAR versus open surgery group (P = 1.0). Sixty-six (50%) patients developed aneurysmal expansion, which required surgical intervention in 26 (hazard ratios [HR], 0.99; P = 0.96). Malperfusion and rupture only occurred in 5 (HR, 1.57; P = 0.54) and 5 (HR, 3.64; P = 0.01) patients, respectively. Multivariate analysis for overall survival found renal insufficiency (HR, 2.6; P = 0.004) and age (HR, 1.06; P < 0.0001) and rupture (HR 3.3, P = 0.04) were independent predictors of mortality. Intramural hematoma was not a significant predictor of survival (HR, 0.49; P = 0.11). CONCLUSIONS Medical therapy remains the mainstay of treating TBAD with low morbidity. Surgical interventions are indicated in selected patients with malperfusion or aneurysmal expansion with comparable survival rates.
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He H, Yao K, Nie W, Wang Z, Liang Q, Shu C, Dardik A. Modified Petticoat Technique with Pre-placement of a Distal Bare Stent Improves Early Aortic Remodeling after Complicated Acute Stanford Type B Aortic Dissection. Eur J Vasc Endovasc Surg 2015; 50:450-9. [DOI: 10.1016/j.ejvs.2015.04.035] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2014] [Accepted: 04/21/2015] [Indexed: 10/23/2022]
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Canaud L, Faure EM, Ozdemir BA, Alric P, Thompson M. Systematic review of outcomes of combined proximal stent-grafting with distal bare stenting for management of aortic dissection. Ann Cardiothorac Surg 2014; 3:223-33. [PMID: 24967161 DOI: 10.3978/j.issn.2225-319x.2014.05.12] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2013] [Accepted: 05/23/2014] [Indexed: 11/14/2022]
Abstract
OBJECTIVE Available data on outcomes of combined proximal stent-grafting with distal bare stenting for management of aortic dissection are limited. The objective of this study was to provide a systematic review of outcomes of this approach. METHODS Studies involving combined proximal stent-grafting with distal bare stenting for management of aortic dissection were systematically searched and reviewed through MEDLINE databases. RESULTS A TOTAL OF FOUR STUDIES WERE INCLUDED: 108 patients treated for management of acute (n=54) and chronic (n=54) aortic dissection. The technical success rate was 95.3% (range, 84-100%). The 30-day mortality rate was 2.7% (range from 0% to 5%). The morbidity rate occurring within 30 days was 51.8% (range from 0% to 65%) and included stroke (2.7%), paraplegia (2.7%), retrograde dissection (1.8%), renal failure (14.8%), severe cardiopulmonary complications (5.5%) and bowel ischemia (0.9%). The incidence of type I endoleak was 9.2% (10/108). During follow-up, 5 (4.6%) deaths were related to aortic rupture or aortic repair. Mean re-intervention rate was 12.9%. Two cases (1.9%) of delayed retrograde type A dissection and one case of aortobronchial fistula (0.9%) were reported. The most common delayed complication was thoracic stent-graft migration (4.7%). The rate of device failure was 9.2%. Favorable aortic remodeling was observed: studies reporting midterm follow-up of the true lumen demonstrated a high rate of both false lumen regression and true lumen expansion. At 12 months, complete false lumen thrombosis was observed at the thoracic level in 70.4% and at the abdominal level in 13.5% of patients. CONCLUSIONS Combined proximal stent-grafting with distal bare stenting appears to be a feasible approach for the management of Type B aortic dissection. Although this approach clearly improved true lumen perfusion and diameter, it failed to completely suppress false lumen patency. However, it should be acknowledged that contemporary data on this approach is limited to small studies with variable results.
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Affiliation(s)
- Ludovic Canaud
- 1 Department of Outcomes Research, St. George's Vascular Institute, London, UK ; 2 Department of Thoracic and Vascular Surgery, A de Villeneuve Hospital, Montpellier, France
| | - Elsa Madeleine Faure
- 1 Department of Outcomes Research, St. George's Vascular Institute, London, UK ; 2 Department of Thoracic and Vascular Surgery, A de Villeneuve Hospital, Montpellier, France
| | - Baris Ata Ozdemir
- 1 Department of Outcomes Research, St. George's Vascular Institute, London, UK ; 2 Department of Thoracic and Vascular Surgery, A de Villeneuve Hospital, Montpellier, France
| | - Pierre Alric
- 1 Department of Outcomes Research, St. George's Vascular Institute, London, UK ; 2 Department of Thoracic and Vascular Surgery, A de Villeneuve Hospital, Montpellier, France
| | - Matt Thompson
- 1 Department of Outcomes Research, St. George's Vascular Institute, London, UK ; 2 Department of Thoracic and Vascular Surgery, A de Villeneuve Hospital, Montpellier, France
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Karmonik C, Müller-Eschner M, Partovi S, Geisbüsch P, Ganten MK, Bismuth J, Davies MG, Böckler D, Loebe M, Lumsden AB, von Tengg-Kobligk H. Computational fluid dynamics investigation of chronic aortic dissection hemodynamics versus normal aorta. Vasc Endovascular Surg 2013; 47:625-31. [PMID: 24048257 DOI: 10.1177/1538574413503561] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To evaluate hemodynamic changes during aneurysmal dilatation in chronic type B aortic dissections compared to hemodynamic parameters in the healthy aorta with the use of computational fluid dynamics (CFD). METHODS True lumen (TL)/false lumen (FL) dimensional changes, changes in total pressure (TP), and wall shear stress (WSS) were evaluated at follow-up (FU) compared to initial examination (IE) with transient CFD simulation with geometries derived from clinical image data and inflow boundary conditions from magnetic resonance images. The TL/FL pressure gradient between ascending and descending aorta (DAo) and maximum WSS at the site of largest dilatation was compared to values for the healthy aorta. RESULTS Hemodynamic changes at site of largest FL dilatation included 77% WSS reduction and 69% TP reduction. Compared to the healthy aorta, pressure gradient between ascending and DAo was a factor of 1.4 higher in the TL and a factor of 1.5 in the FL and increased at FU (1.6 and 1.7, respectively). Maximum WSS at the site of largest dilatation was a factor of 3 lower than that for the healthy aorta at IE and decreased by more than a factor of 2 at FU. CONCLUSIONS The FL dilatation at FU favorably reduced TP. In contrast, unfavorable increase in pressure gradient between ascending and DAo was observed with higher values than in the healthy aorta. Maximum WSS was reduced at the site of largest dilation compared to healthy aorta.
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Affiliation(s)
- Christof Karmonik
- 1Department of Cardiovascular Surgery, Methodist DeBakey Heart and Vascular Center, Houston, TX, USA
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Systematic review of outcomes of combined proximal stent grafting with distal bare stenting for management of aortic dissection. J Thorac Cardiovasc Surg 2013; 145:1431-8. [DOI: 10.1016/j.jtcvs.2013.02.060] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2012] [Revised: 02/06/2013] [Accepted: 02/27/2013] [Indexed: 11/18/2022]
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Jun H, Cho YP, Ko GY, Choo SJ, Kwon TW. Hybrid Repair of Type III Thoracoabdominal Aortic Aneurysm with Pre-Occluded Visceral Arteries. Vasc Specialist Int 2013. [DOI: 10.5758/kjves.2013.29.2.63] [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] Open
Affiliation(s)
- Heungman Jun
- Department of Surgery, Sun General Hospital, Daejeon, Korea
| | - Yong-Pil Cho
- Division of Vascular Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Gi-Young Ko
- Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Suk-Jung Choo
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Tae-Won Kwon
- Division of Vascular Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Qin YL, Deng G, Li TX, Jing RW, Teng GJ. Risk factors of incomplete thrombosis in the false lumen after endovascular treatment of extensive acute type B aortic dissection. J Vasc Surg 2012; 56:1232-8. [DOI: 10.1016/j.jvs.2012.04.019] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2011] [Revised: 03/09/2012] [Accepted: 04/08/2012] [Indexed: 11/25/2022]
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Pires de Morais G, Rodrigues A, Gama V. Treatment of type-a aortic dissection using endoprosthesis occurring after coronary artery bypass surgery. Catheter Cardiovasc Interv 2012; 80:1099-104. [DOI: 10.1002/ccd.23462] [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] [Received: 05/21/2011] [Accepted: 10/31/2011] [Indexed: 11/11/2022]
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Karmonik C, Duran C, Shah DJ, Anaya-Ayala JE, Davies MG, Lumsden AB, Bismuth J. Preliminary findings in quantification of changes in septal motion during follow-up of type B aortic dissections. J Vasc Surg 2012; 55:1419-26. [PMID: 22342152 DOI: 10.1016/j.jvs.2011.10.127] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2011] [Revised: 10/24/2011] [Accepted: 10/30/2011] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To quantify longitudinal changes in intra-arterial septum (IS) motion with two-dimensional (2D) phase-contrast magnetic resonance imaging (2D pcMRI) in type B aortic dissections (AD) to improve the understanding of AD and its midterm development. METHODS From a database of 42 patients who underwent a dynamic magnetic resonance imaging (MRI) examination at the Acute Aortic Treatment Center of The Methodist DeBakey Heart & Vascular Center, 2D pcMRI image data was available from 10 patients with type B AD for both short-term (mean, 6.6 days; range, 1-10 days; n = 7) and midterm follow-up (mean, 155 days; range, 60-324; n = 5). IS motion was quantified as motion of IS boundary points averaged over the cardiac cycle. Relative change in IS motion was expressed as percent change compared with initial presentation. Maximum IS extension (true lumen [TL] expansion) and contraction (TL compression), IS fraction in phase with aortic flow and correlation of IS motion with aortic flow (IS compliance) were quantified. RESULTS IS motion at initial presentation was 0.68 ± 0.2 mm and was reduced at short-term (0.48 ± 0.3 mm; P = .07) and midterm (0.5 ± 0.2 mm; P = .1) follow-up. Trend in relative change of IS motion was variable during short-term follow-up: reduced in three subjects (-75% ± 6%) and elevated in four subjects (48% ± 23%). During midterm follow-up, relative change in IS motion was reduced in four subjects (28% ± 19%) and slightly elevated in one (6.2%). IS contraction decreased with follow-up while IS extension slightly increased. Fraction of IS moving in phase with aortic flow increased but IS compliance decreased, suggesting increasing IS stiffness. CONCLUSIONS Reduction of IS motion in AD is seen with short-term and midterm follow-up. Intersubject variability of this trend is high at short-term follow-up but low at midterm follow-up. Detailed analysis of IS motion parameters indicate reduction of IS contraction and IS compliance with time. This has potential implications for endovascular management of type B aortic dissections, as expansion of aortic stent grafts can be limited by a stiff IS.
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Affiliation(s)
- Christof Karmonik
- Methodist Hospital, Methodist DeBakey Heart & Vascular Center, Houston, TX, USA.
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Oberhuber A, Winkle P, Schelzig H, Orend KH, Muehling BM. Technical and clinical success after endovascular therapy for chronic type B aortic dissections. J Vasc Surg 2011; 54:1303-9. [DOI: 10.1016/j.jvs.2011.05.020] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2011] [Revised: 05/03/2011] [Accepted: 05/04/2011] [Indexed: 11/27/2022]
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Shu C, He H, Li QM, Li M, Jiang XH, Luo MY. Endovascular Repair of Complicated Acute Type-B Aortic Dissection with Stentgraft: Early and Mid-term Results. Eur J Vasc Endovasc Surg 2011; 42:448-53. [DOI: 10.1016/j.ejvs.2011.05.013] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2010] [Accepted: 05/13/2011] [Indexed: 10/18/2022]
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Naughton PA, Garcia-Toca M, Matsumura JS, Rodriguez HE, Morasch MD, Resnick SA, Eskandari MK. Complicated acute type B thoracic aortic dissections: endovascular treatment for visceral malperfusion and pseudoaneurysms. Vasc Endovascular Surg 2011; 45:219-26. [PMID: 21478244 DOI: 10.1177/1538574410395039] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE Morbidity and mortality of acute type B thoracic aortic dissections remain alarmingly high. Endoluminal options are promising. METHODS A single-center 5-year review of 17 acute type B aortic dissections complicated by visceral malperfusion (11) or pseudoaneurysm formation (6) treated with endovascular intervention. Interventional techniques included endografting (15) and/or percutaneous fenestration (4). Median follow-up is 28 months (range 0-76 months). RESULTS Median age was 55 years; 30-day death, stroke, and paraplegia rates were 0%, 17.6%, and 5.9%. Success reversing visceral ischemia or sealing a pseudoaneurysm was 100%. Cross-sectional imaging demonstrated that the false lumen was thrombosed in 9 patients, partially thrombosed in 6 patients. Late events include 1 delayed proximal type I endoleak, 1 delayed rupture of the thoracic aorta requiring successful emergent open surgical repair, and 2 unrelated late deaths. CONCLUSION Endovascular approaches to type B dissections presenting with visceral malperfusion and/or pseudoaneurysm can achieve acceptable early results.
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Affiliation(s)
- Peter A Naughton
- Division of Vascular Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA
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Nienaber CA, Ince H. Stent-grafts for aortic dissection: what is really needed? J Endovasc Ther 2011; 18:144-5. [PMID: 21521052 DOI: 10.1583/10-3233c.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Zipfel B, Czerny M, Funovics M, Coppi G, Ferro C, Rousseau H, Berti S, Tealdi DG, Riambau V, Mangialardi N, Sassi C. Endovascular Treatment of Patients With Types A and B Thoracic Aortic Dissection Using Relay Thoracic Stent-Grafts: Results From the RESTORE Patient Registry. J Endovasc Ther 2011; 18:131-43. [DOI: 10.1583/10-3233mr.1] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Ham SW, Rowe VL, Ochoa C, Chong T, Lee WM, Baker CJ, Cohen RG, Cunningham MJ, Weaver FA, Woo K. Thoracic Aortic Stent-Grafting for Acute, Complicated, Type B Aortic Dissections. Ann Vasc Surg 2011; 25:333-9. [PMID: 21276707 DOI: 10.1016/j.avsg.2010.09.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2010] [Revised: 09/16/2010] [Accepted: 09/20/2010] [Indexed: 11/29/2022]
Affiliation(s)
- Sung Wan Ham
- Aortic Center, Cardio-Vascular Thoracic Institute, The University of Southern California, Department of Surgery, 1520 S. San Pablo St., Los Angeles, CA 90033, USA
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Zeeshan A, Woo EY, Bavaria JE, Fairman RM, Desai ND, Pochettino A, Szeto WY. Thoracic endovascular aortic repair for acute complicated type B aortic dissection: Superiority relative to conventional open surgical and medical therapy. J Thorac Cardiovasc Surg 2010; 140:S109-15; discussion S142-S146. [PMID: 21092775 DOI: 10.1016/j.jtcvs.2010.06.024] [Citation(s) in RCA: 123] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2010] [Accepted: 06/12/2010] [Indexed: 10/18/2022]
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