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Zhou K, Duan H, Hu H, Guo Q, Zhao J. Reconstruction of the accessory renal artery with autogenous vessels in aortic hybrid surgery: A case report. Vascular 2024; 32:756-759. [PMID: 36794789 DOI: 10.1177/17085381231154817] [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: 02/17/2023]
Abstract
OBJECTIVE Accessory renal artery (ARA) is a common variant of renal vessels. Currently, there are some controversies about reconstruction strategy and few cases reported in the literature. Individualized treatment should be carried out according to preoperative renal function evaluation and technical level. METHODS In this paper, a 50-year-old male patient was reported, who developed a dissecting aneurysm after thoracic endovascular aortic repair (TEVAR) and needed further intervention. Imaging showed that the left kidney was supplied by bilateral renal artery (false lumens), and there were left renal malperfusion complicated with abnormal renal function. RESULTS Autologous blood vessels were used to successfully reconstruct ARA with during hybrid surgery. Renal perfusion and renal function recovered rapidly after operation. There was no abnormality in renal indexes after 3 months follow-up. CONCLUSION It is beneficial and necessary to reconstruct ARA for patients with renal malperfusion or abnormal renal function before operation.
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Affiliation(s)
- Kun Zhou
- Department of Vascular Surgery, Taihe Hospital, Hubei University of Medicine, Shiyan, China
| | - Hui Duan
- Department of Emergency Medicine, Taihe Hospital, Hubei University of Medicine, Shiyan, China
| | - Hankui Hu
- Department of Vascular Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Qiang Guo
- Department of Vascular Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Jichun Zhao
- Department of Vascular Surgery, West China Hospital, Sichuan University, Chengdu, China
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Berretta P, Galeazzi M, Malvindi PG, Cefarelli M, Alfonsi J, Bifulco O, Gatta E, Di Eusanio M. Frozen elephant use in type a dissection: fundamentals, innovations, and pitfalls. Expert Rev Med Devices 2024; 21:579-586. [PMID: 38841791 DOI: 10.1080/17434440.2024.2365416] [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] [Received: 02/17/2024] [Accepted: 06/04/2024] [Indexed: 06/07/2024]
Abstract
INTRODUCTION Type A acute aortic dissection (TA-AAD) is a great challenge for aortic surgeons. The establishment of a standardized surgical approach, particularly the determination of whether and when to address the aortic arch and the distal aorta in the same operation as the proximal aorta, is still unclear. AREAS COVERED Frozen elephant trunk (FET) has emerged as a valuable treatment for TA-AAD over the last decade. Here, we discuss the fundamentals and pitfalls of frozen elephant trunk procedures and present the latest innovations. EXPERT OPINION FET has the potential to simplify arch reconstruction in patients with complex arch tears and rupture, optimize perfusion in the distal true lumen for those with a compressed true lumen and malperfusion, address distal reentry tears, and promote false lumen thrombosis and late aortic remodeling. Nevertheless, FET is still associated with non-negligible mortality and morbidity rates. Patient selection, surgical expertise, and postoperative care remain crucial determinants in ensuring successful outcomes. Recent innovations in FET surgery involve the development of techniques to minimize or avoid hypothermic circulatory arrest and new FET devices with different arch branch configurations aiming to facilitate subsequent aortic reinterventions. We believe that both these advancements have the potential to improve patient outcomes.
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Affiliation(s)
- Paolo Berretta
- Cardiac Surgery Unit, Lancisi Cardiovascular Center, Polytechnic University of Marche, Ancona, Italy
| | - Michele Galeazzi
- Cardiac Surgery Unit, Lancisi Cardiovascular Center, Polytechnic University of Marche, Ancona, Italy
| | - Pietro G Malvindi
- Cardiac Surgery Unit, Lancisi Cardiovascular Center, Polytechnic University of Marche, Ancona, Italy
| | - Mariano Cefarelli
- Cardiac Surgery Unit, Lancisi Cardiovascular Center, Polytechnic University of Marche, Ancona, Italy
| | - Jacopo Alfonsi
- Cardiac Surgery Unit, Lancisi Cardiovascular Center, Polytechnic University of Marche, Ancona, Italy
| | - Olimpia Bifulco
- Cardiac Surgery Unit, Lancisi Cardiovascular Center, Polytechnic University of Marche, Ancona, Italy
- Cardiac Surgery Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padova, Italy
| | - Emanuele Gatta
- Vascular Surgery Unit, Lancisi Cardiovascular Center, Polytechnic University of Marche, Ancona, Italy
| | - Marco Di Eusanio
- Cardiac Surgery Unit, Lancisi Cardiovascular Center, Polytechnic University of Marche, Ancona, Italy
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Ferraresi M, Molinari ACL, Katsarou M, Rossi G. Volumetric analysis in primary and residual type B aortic dissection treated with stented-assisted balloon-induced intimal disruption and relamination technique can predict aortic reintervention. J Vasc Surg 2024; 79:1315-1325. [PMID: 38382641 DOI: 10.1016/j.jvs.2024.02.017] [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] [Received: 10/31/2023] [Revised: 02/09/2024] [Accepted: 02/13/2024] [Indexed: 02/23/2024]
Abstract
OBJECTIVE The aim of this study was to investigate the mid-term results of stented-assisted balloon-induced intimal disruption and relamination (STABILISE) in patients with aortic dissection with the implementation of volumetric analysis. METHODS This was a single-center retrospective analysis of prospectively collected data. From May 2017 to September 2022, 42 patients underwent STABILISE for acute complicated or subacute high-risk aortic dissection. STABILISE was completed with distal extended endovascular aortic repair in 24 patients. A computed tomography scan was performed at baseline, before hospital discharge, and at 1, 3, and 5 years. Perfused total aortic, true lumen, and false lumen volumes were assessed for thoracic, visceral, and aorto-iliac segment. The ratio between false lumen and total volume was named perfusion dissection index (PDI). Complete remodeling was defined as PDI = 0, and positive remodeling as PDI ≤0.1. RESULTS Technical success was 97.6%. No 30-day deaths, spinal cord injuries, or retrograde dissections were observed. Mean follow-up was 44 ± 19.4 months. Thoracic diameter was lower at last available computed tomography scan (36.7 vs 33.0 mm; P = .01). Aortic growth >5 mm was observed in 9.5% of the patients. Thoracic and visceral aortic complete remodeling were 92.8% and 83.3%, respectively, with no difference between acute and subacute group. Distal extended endovascular aortic repair significantly increased complete remodeling in the aorto-iliac segment, compared with STABILISE alone (69.6% vs 21.4%; P < .001). Freedom from vascular reinterventions at 3 years was 83.1% (95% confidence interval, 71.5%-96.6%). Total PDI ≤0.1 at first postoperative control was a predictor of vascular reinterventions (P < .0001). CONCLUSIONS STABILISE is a safe and feasible technique associated with high mid-term rates of complete remodeling in the thoracic and visceral aorta. Volumetric analysis allows the quantification of aortic remodeling and represents a predictor of aortic reinterventions.
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Affiliation(s)
- Marco Ferraresi
- Division of Vascular Surgery, Cardio-Thoraco-Vascular Department, A. Manzoni Hospital, Lecco, Italy.
| | | | - Maria Katsarou
- Division of Vascular Surgery, Cardio-Thoraco-Vascular Department, A. Manzoni Hospital, Lecco, Italy
| | - Giovanni Rossi
- Division of Vascular Surgery, Cardio-Thoraco-Vascular Department, A. Manzoni Hospital, Lecco, Italy
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White A, Elfaki L, O'Brien D, Manikala V, Bozso S, Ouzounian M, Moon MC. The Use of the Ascyrus Medical Dissection Stent in Acute Type A Aortic Dissection Repair Reduces Distal Anastomotic New Entry Tear. Can J Cardiol 2024; 40:470-475. [PMID: 37839655 DOI: 10.1016/j.cjca.2023.09.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 08/30/2023] [Accepted: 09/09/2023] [Indexed: 10/17/2023] Open
Abstract
BACKGROUND A distal anastomotic new entry tear (DANE) can occur at the time of surgical repair for acute type A aortic dissection (ATAAD). This study aimed to compare the occurrence of DANE following a standard hemiarch repair with that following a hemiarch repair with an uncovered arch dissection stent. METHODS All patients who received a hemiarch repair or a hemiarch repair with an Ascyrus Medical Dissection Stent (AMDS) for ATAAD from 2017 to 2021 were included. Baseline and intra- and postoperative characteristics were collected. All available pre- and postoperative computed tomographic scans were analysed. The primary outcome measures were the incidence of DANE, positive aortic remodelling, mortality, and aortic reintervention rates at last follow-up. RESULTS A total of 114 patients underwent repair of Debakey I ATAAD during the study period with either an isolated hemiarch (n = 77) or a hemiarch with AMDS (n = 37). There was no significant difference in mortality (P = 0.768) or other in-hospital adverse events. During the follow-up period, DANE occurred in 43.3% (n = 26) of the isolated hemiarch group and in 11.8% (n = 4) of the hemiarch with AMDS group (P = 0.002). The incidence of false lumen thrombosis and obliteration favoured the AMDS group in the aortic arch (P = 0.029), the proximal descending thoracic aorta (P = 0.031), and level of pulmonary artery bifurcation (P = 0.044). CONCLUSIONS The incidence of DANE is significantly reduced with the addition of an AMDS at the time of hemiarch repair for ATAAD repair. Further follow-up is necessary to identify late aortic complications that may have been prevented by reducing the incidence of postoperative DANE.
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Affiliation(s)
| | - Lina Elfaki
- University of Toronto, Toronto, Ontario, Canada
| | | | | | - Sabin Bozso
- University of Alberta, Edmonton, Alberta, Canada
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Li R, Liu Y, Jiang J. Case Report: The application of amplatzer vascular plug to repair aortic dissection intimal tears and false lumen. Front Cardiovasc Med 2024; 10:1337430. [PMID: 38259321 PMCID: PMC10801193 DOI: 10.3389/fcvm.2023.1337430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 12/21/2023] [Indexed: 01/24/2024] Open
Abstract
In recent years, significant advancements have been made in endovascular therapy for aortic dissection, resulting in the development of various treatment methods. Nevertheless, there is a contentious discussion regarding the suitability of different treatment methods for addressing the unique features of individual lesions. Specifically, the matter of whether the presence of small intimal tears or multiple distal tears requires extensive aortic coverage with graft stents, which may block the blood supply to important organs, intercostal arteries, or lumbar arteries, remains unresolved. Further research is necessary to determine the need for complex fenestrated or branched endovascular aortic repair (F/B-EVAR) in the management of chronic post-dissection aneurysms involving visceral arteries. Our report highlights the successful endovascular repair of three patients with aortic dissection, encompassing one Stanford A type and two Stanford B types. Utilizing the Amplatzer Vascular Plug (AVP) alone or in combination with the coil embolization technique, we achieved favorable clinical outcomes. This article aims to provide valuable insights and new perspectives on the tailored management of aortic dissection by conducting a comprehensive examination of the subtle differences in the treatment processes and techniques applied to these three patients.
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Affiliation(s)
| | | | - Jianjun Jiang
- Department of General Surgery, Vascular Surgery, Qilu Hospital of Shandong University, Jinan, Shandong, China
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Zhang Z, Lin F, Huang X, He Z, Wang H, Cheng T. Age-related difference in acute type B aortic dissection. Vascular 2023:17085381231214720. [PMID: 37940108 DOI: 10.1177/17085381231214720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2023]
Abstract
OBJECTIVE The objective is to compare the characteristics of clinical data, imaging data, and treatment methods of young and old patients with acute type B aortic dissection (ABAD). METHODS ABAD patients admitted to the Department of Vascular Surgery of the First Affiliated Hospital of Anhui Medical University from January 2012 to December 2018 were retrospectively reviewed. Patient demographics, such as gender, age, diabetes, hypertension, presenting symptoms, imaging characteristics, laboratory data on admission, hemodynamics on admission and in-hospital management, and mortality of different age groups were compared and analyzed. Categorical variables were compared using χ2 tests or Fisher's exact test. Continuous variables were compared using Student's t-test or Mann-Whitney U-test. RESULTS A total of 141 ABAD patients were included in this study. Old ABAD patients were more likely to have a prior history of hypertension (88.6% vs 70.4%, p = 0.037) and atherosclerosis (29.8% vs 7.4%, p = 0.016). In the young group, Marfan syndrome was significantly higher (14.8% vs 0.9%; p = 0.005). Compared with the old group, the number of distal tears in the young group was significantly higher (62.3% vs 39.5%, p = 0.027). The proportion of patients with malperfusion of lower limbs in the young group was significantly higher than that in the old group (22.2% vs 6.1%, p = 0.026). There was no significant difference in the treatment methods and in-hospital mortality between the two groups. CONCLUSION Compared with old ABAD patients, young ABAD patients had more distal tears and a higher proportion of lower limbs malperfusion.
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Affiliation(s)
- Zhigong Zhang
- Department of General Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Feng Lin
- Department of General Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, China
- Anhui Public Health Clinical Center, Hefei, China
| | - Xiaoci Huang
- Department of Anaesthesiology, The Second Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Zhipeng He
- Department of General Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Haoran Wang
- Department of General Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Tingting Cheng
- Department of General Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, China
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Kuo CY, Huang CY, Chen TW, Hsu HL, Shih CC, Hsu CP. Outcomes of abdominal false lumen embolization for chronic aortic dissection after prior proximal repair with stent-graft. J Chin Med Assoc 2023; 86:633-640. [PMID: 37185220 DOI: 10.1097/jcma.0000000000000934] [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: 05/17/2023] Open
Abstract
BACKGROUND Persistent false lumen (FL) perfusion with aneurysmal formation is common after thoracic endovascular aortic repair (TEVAR) for typical extended aortic dissection and is associated with poor outcomes. Endovascular FL embolization (FLE) has recently been tried for treatment of postdissection aortic aneurysm (PDAA). However, most reports address thoracic rather than abdominal FLE. In this study, we present the results of abdominal FLE in patients with residual patent abdominal FL following stent-graft repair for aortic dissection. METHODS Between 2015 and 2019, 24 patients (mean age: 56.7 ± 11.8 years, range: 40-84 years, 18 male) received endovascular abdominal FLE using vascular plugs, coils, or candy plugs as the main surgery (5 patients) or auxiliary procedure (19 patients) after earlier stent-graft repair for aortic dissection (Type A: 9, Type B: 15). The medical records were reviewed and aortic remodeling was examined comparing the preembolization computed tomography (CT) and the most recent CT before reintervention. RESULTS Technical success was achieved without any intraoperative complications, early morbidity, or mortality. Median follow-up was 34.4 months (range: 12-71). Regarding thoracic FL, 15 patients exhibited complete thrombosis before the procedure and did not change status thereafter except for 1 patient with distal stent-graft-induced new entry. In the other 9 patients, 6 exhibited increased thrombosis. With regard to the abdominal aorta, increased FL thrombosis only occurred in 8 patients with 3 (12.5%) achieving complete thrombosis. The maximal thoracic aortic diameter did not change (1.4 ± 5.6 mm) statistically, but the abdominal diameter increased significantly (4.3 ± 3.7 mm, p < 0.005). CONCLUSION From our results, abdominal FLE is a safe procedure. However, covering all the re-entry tears is complex and the possibility of complete FL thrombosis is low. The abdominal aortic diameter appears to become enlarged in these patients. Continuous follow-up is necessary after FLE.
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Affiliation(s)
- Ching-Yuan Kuo
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Division of Cardiovascular Surgery, Department of Surgery, Taipei Veterans General Hospital, Taiwan, ROC
| | - Chun-Yang Huang
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Division of Cardiovascular Surgery, Department of Surgery, Taipei Veterans General Hospital, Taiwan, ROC
| | - Tai-Wei Chen
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Division of Cardiovascular Surgery, Department of Surgery, Taipei Veterans General Hospital, Taiwan, ROC
| | - Hung-Lung Hsu
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Department of Cardiovascular Surgery, Far Eastern Memorial Hospital, New Taipei City, Taiwan, ROC
| | - Chun-Che Shih
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Division of Cardiovascular Surgery, Department of Surgery, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan, ROC
| | - Chiao-Po Hsu
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Division of Cardiovascular Surgery, Department of Surgery, Taipei Veterans General Hospital, Taiwan, ROC
- Department of Surgery, Taoyuan General Hospital, Ministry of Health and Welfare, Taoyuan, Taiwan, ROC
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Tang QH, Chen J, Long Z, Wang YL, Su XA, Qiu JY, Lin QN, Zhang JF, Qin X. Factors affecting distal false lumen enlargement after thoracic endovascular aortic repair for type B aortic dissection. Heliyon 2023; 9:e17248. [PMID: 37383200 PMCID: PMC10293708 DOI: 10.1016/j.heliyon.2023.e17248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 06/09/2023] [Accepted: 06/12/2023] [Indexed: 06/30/2023] Open
Abstract
Objective To investigate the factors influencing distal false lumen enlargement after thoracic endovascular aortic repair (TEVAR) for type B aortic dissection. Materials and methods Data were collected on patients with type B aortic dissection who underwent TEVAR from January 2008 to August 2022. Patients were divided into a distal aortic segmental enlargement (DSAE) group and a non-DSAE group based on whether the distal false lumen was dilated more than 5 mm on computed tomographic angiography (CTA) images. To analyze the independent influences on distal false lumen dilatation after TEVAR, the variables with a P value < 0.05 during univariate analysis were included in the binary logistic regression analysis model. Results A total of 335 patients were included in this study, with 85 in the DSAE group and 250 in the non-DSAE group. The mean age was 52.40 ± 11.34 years, 289 (86.27%) were male patients, and the median follow-up time was 6.41 (11.99-29.99) months. There were significant differences in Marfan syndrome, chronic obstructive pulmonary disease (COPD), and follow-up time between the two groups. In terms of morphology, there were statistically significant differences in the number of tears, the size of the primary tear, and the length of dissection between the two groups. Binary logistic regression analysis indicated that Marfan syndrome, COPD, and the primary tear size were associated with distal false lumen dilatation. Conclusions Marfan syndrome, COPD, and the primary tear size influence distal aortic segmental enlargement after TEVAR in type B aortic dissection patients.
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Dong Z, Yang H, Li G, Xu X, Liu H, Gu J, Li M, Gu W, Shao Y, Ni B. Preoperative Predictors of Late Aortic Expansion in Acute Type B Aortic Dissection Treated with TEVAR. J Clin Med 2023; 12:jcm12082826. [PMID: 37109163 PMCID: PMC10141654 DOI: 10.3390/jcm12082826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Revised: 03/10/2023] [Accepted: 04/07/2023] [Indexed: 04/29/2023] Open
Abstract
BACKGROUND A patent false lumen (FL) in patients with thoracic endovascular aortic repair (TEVAR)-treated type B aortic dissection (TBAD) can cause a significant risk for late aortic expansion (LAE). We hypothesize that preoperative features can predict the occurrence of LAE. METHODS Sufficient preoperative and postoperative follow-up clinical and imaging feature data for patients treated with TEVAR in the First Affiliated Hospital of Nanjing Medical University from January 2018 to December 2020 were collected. A univariate analysis and multivariable logistic regression analysis were used to find potential risk factors of LAE. RESULTS Ninety-six patients were finally included in this study. The mean age was 54.5 ± 11.7 years and 85 (88.5%) were male. LAE occurred in 15 (15.6%) of 96 patients after TEVAR. Two preoperative factors showed strong associations with LAE according to the multivariable logistic regression analysis: preoperative partial thrombosis of the FL (OR = 10.989 [2.295-48.403]; p = 0.002) and the maximum descending aortic diameter (OR = 1.385 [1.100-1.743] per mm increase; p = 0.006). CONCLUSIONS Preoperative partial thrombosis of the FL and an increase in the maximum aortic diameter are strongly associated with late aortic expansion. Additional interventions of the FL may help to improve the prognosis of patients with the high risk of late aortic expansion.
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Affiliation(s)
- Zhiqiang Dong
- Department of Cardiovascular Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210003, China
| | - He Yang
- Department of Thoracic Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210003, China
| | - Gang Li
- Department of Cardiovascular Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210003, China
| | - Xinyang Xu
- Department of Cardiovascular Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210003, China
| | - Hong Liu
- Department of Cardiovascular Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210003, China
| | - Jiaxi Gu
- Department of Cardiovascular Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210003, China
| | - Minghui Li
- Department of Cardiovascular Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210003, China
| | - Weidong Gu
- Department of Cardiovascular Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210003, China
| | - Yongfeng Shao
- Department of Cardiovascular Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210003, China
| | - Buqing Ni
- Department of Cardiovascular Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210003, China
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CHEN B, WANG J. Impact and risk factors associated with false lumen thrombus status within stent segments of type B aortic dissection after endovascular repair. ITALIAN JOURNAL OF VASCULAR AND ENDOVASCULAR SURGERY 2022. [DOI: 10.23736/s1824-4777.22.01541-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Li Z, Xu H, Armour CH, Guo Y, Xiong J, Xu X, Chen D. The Necessity to Seal the Re-Entry Tears of Aortic Dissection After TEVAR: A Hemodynamic Indicator. Front Bioeng Biotechnol 2022; 10:831903. [PMID: 35433660 PMCID: PMC9009393 DOI: 10.3389/fbioe.2022.831903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 01/11/2022] [Indexed: 11/13/2022] Open
Abstract
Thoracic endovascular aortic repair (TEVAR) is a common treatment for Stanford type B aortic dissection (TBAD). However, re-entry tears might be found distal to the stented region which transports blood between the true and false lumens. Sealing the re-entry tears, especially for the thoracic tears, could further reduce blood perfusion to the false lumen; however, it might also bring risks by re-intervention or surgery. Wise determination of the necessity to seal the re-entry tears is needed. In this study, patient-specific models of TBAD were reconstructed, and the modified models were established by virtually excluding the thoracic re-entries. Computational hemodynamics was investigated, and the variation of the functional index and first balance position (FBP) of the luminal pressure difference, due to the sealing of the re-entries, was reported. The results showed that the direction of the net flow through the unstented thoracic re-entries varied among cases. Excluding the re-entries with the net flow toward the false lumen may induce the FBP moving distally and the relative particle residence time increasing in the false lumen. This study preliminarily demonstrated that the hemodynamic status of the re-entry tears might serve as an indicator to the necessity of sealing. By quantifying the through-tear flow exchange and shift of FBP, one can predict the hemodynamic benefit by sealing the thoracic re-entries and thus wisely determine the necessity of further interventional management.
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Affiliation(s)
- Zhenfeng Li
- School of Life Science, Beijing Institute of Technology, Beijing, China
- Wenzhou Safety (Emergency) Institute of Tianjin University, Zhejiang, China
| | - Huanming Xu
- School of Life Science, Beijing Institute of Technology, Beijing, China
| | - Chlöe Harriet Armour
- Department of Chemical Engineering, Imperial College London, London, United Kingdom
| | - Yuze Guo
- School of Biomedical Engineering, University of Sydney, Sydney, NSW, Australia
| | - Jiang Xiong
- Department of Vascular and Endovascular Surgery, Chinese PLA General Hospital, Beijing, China
- *Correspondence: Jiang Xiong, ; Xiaoyun Xu,
| | - Xiaoyun Xu
- Department of Chemical Engineering, Imperial College London, London, United Kingdom
- *Correspondence: Jiang Xiong, ; Xiaoyun Xu,
| | - Duanduan Chen
- School of Life Science, Beijing Institute of Technology, Beijing, China
- Wenzhou Safety (Emergency) Institute of Tianjin University, Zhejiang, China
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Wang R, Kan Y, Yang M, Zhang H, Zhang X, Dai X, Zhai S, Hu H, Zhang X, Chen B, Huang J, Qin X, Xiao Z, Lu X, Guo W, Si Y, Fu W. Clinical Results and Aortic Remodeling After Endovascular Treatment for Complicated Type B Aortic Dissection With the “Fabulous” Stent System. Front Cardiovasc Med 2022; 9:817675. [PMID: 35237674 PMCID: PMC8882966 DOI: 10.3389/fcvm.2022.817675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Accepted: 01/14/2022] [Indexed: 12/03/2022] Open
Abstract
Objective To report the clinical outcomes and aortic remodeling after the implantation of a self-developed, biomechanically optimized, two-stage thoracic stent system named Fabulous. Background Given the efficacy of the PETTICOAT concept, the benefits of Fabulous and the behavior of remodeling in different segments need further investigation. Methods This is a prospective and multicenter study. From 2017 to 2019, 145 patients (mean age, 56.6 years; 88.3% male) from 14 centers were included in this cohort. The clinical results and core laboratory results were from a central electronic data capture system. Computed tomographic angiography was performed preoperatively, 1 month, 6 months and yearly thereafter and was used for volumetric analysis by 3mensio (Bilthoven, The Netherlands). After the 1-year follow-up, 97.2 and 87.6% of the clinical and imaging results of the eligible patients were available. Results Both stent grafts and bare stents were successfully delivered in place in 100% of the patients. The 30-day mortality and 1-year freedom from all-cause mortality were 2.1 and 96.6%, respectively. The incidence of entry flow was 11.7% at 30 days and 6.2% at 365 days. No cases of stent-induced new entry (SINE) or reintervention were observed. After the 1-year follow-up, the true lumen/overall volume ratio reached 88%. The following subdivided segment volume changes were recorded: stent graft segment TL +56%; FL −92%, bare stent segment TL +32%; FL −75%, and there were no significant changes in the visceral segment. Conclusions These outcomes indicated that there were favorable clinical benefits of Fabulous stent system. This device achieved a low short-term mortality and a low incidence of reintervention. In addition, patients undergoing Fabulous stent system implantation showed remodeling both on descending aorta and on the distal aorta. The volume changes in the TL and FL varied in the different segments. The long-term follow-up is still ongoing.
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Affiliation(s)
- Ruihan Wang
- Department of Vascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Yuanqing Kan
- Department of Vascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Mou Yang
- Vascular Surgery, Yantai Yuhuangding Hospital Affiliated With Qingdao University, Yantai, China
| | - Hongkun Zhang
- Department of Vascular Surgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Xiaoming Zhang
- Department of Vascular Surgery, Peking University People's Hospital, Beijing, China
| | - Xiangchen Dai
- Department of General Surgery, Tianjin Medical University General Hospital, Tianjin, China
| | - Shuiting Zhai
- Department of Vascular and Endovascular Surgery, Henan Provincial People's Hospital, Zhengzhou University, Zhengzhou, China
| | - Hejie Hu
- Department of Vascular Surgery, The First Affiliated Hospital of USTC, Hefei, China
| | - Xiwei Zhang
- Department of Vascular Surgery, Jiangsu Province Hospital, Nanjing, China
| | - Bing Chen
- Department of Vascular Surgery, School of Medicine, Second Affiliated Hospital, Zhejiang University, Hangzhou, China
| | - Jianhua Huang
- Department of General and Vascular Surgery, Xiangya Hospital, Central South University, Changsha, China
| | - Xiao Qin
- Department of Vascular Surgery, The First Affiliated Hospital of Guangxi Medical University, Guangxi, China
| | - Zhanxiang Xiao
- Department of General Surgery, Hainan Province People's Hospital, Haikou, China
| | - Xinwu Lu
- Department of Vascular Surgery, Shanghai Ninth People's Hospital, Shanghai, China
| | - Wei Guo
- Department of Vascular and Endovascular Surgery, Chinese PLA General Hospital, Beijing, China
| | - Yi Si
- Department of Vascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
- *Correspondence: Yi Si
| | - Weiguo Fu
- Department of Vascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
- Weiguo Fu
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Tanda E, Genadiev GG, Zappadu S, Donno GD, Camparini S. Spontaneous Isolated Dissection of Iliac Artery Treated with Endovascular Repair: A Case Report. Vasc Specialist Int 2021; 37:38. [PMID: 34961749 PMCID: PMC8720578 DOI: 10.5758/vsi.210040] [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: 06/03/2021] [Revised: 11/23/2021] [Accepted: 12/09/2021] [Indexed: 11/20/2022] Open
Abstract
Spontaneous isolated dissection of the iliac artery (SID-IA) is a rare pathologic condition. The predisposing factors and best treatment strategies are still being debated. We present the case of a 59-year-old male with acute right lower limb ischemia characterized by the sudden occurrence of rest pain, hypoesthesia, and paresis. Angiography showed SID-IA extending down to the femoral bifurcation. The patient had no risk factors for SID-IA; however, he survived an electrocution and had arterial hypertension at admission. Endovascular revascularization was successfully performed, with complete restoration of limb blood flow and remission of symptoms. Follow-up ultrasonography at 1 year confirmed stent patency and absence of clinical symptoms. Endovascular stenting is a good therapeutic option for symptomatic SID-IA without rupture.
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Affiliation(s)
- Elisabetta Tanda
- Vascular Surgery Service, Cardiovascular Department, San Michele Hospital, ARNAS "G. Brotzu.,Department of Surgery, University of Cagliari, Monserrato, Italy
| | - Genadi G Genadiev
- Vascular Surgery Service, Cardiovascular Department, San Michele Hospital, ARNAS "G. Brotzu
| | - Sara Zappadu
- Vascular Surgery Service, Cardiovascular Department, San Michele Hospital, ARNAS "G. Brotzu.,Department of Surgery, University of Cagliari, Monserrato, Italy
| | - Gabriele De Donno
- Vascular Surgery Service, Cardiovascular Department, San Michele Hospital, ARNAS "G. Brotzu.,Department of Surgery, University of Cagliari, Monserrato, Italy
| | - Stefano Camparini
- Vascular Surgery Service, Cardiovascular Department, San Michele Hospital, ARNAS "G. Brotzu
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14
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Cuellar-Calabria H, Burcet G, Roque A, Rodríguez-Palomares J, Teixidó G, Rodríguez R, Bellmunt S, Zebdi N, Reyes-Juárez J, Sao-Avilés A, Escobar M, Evangelista A. Differences in the Area of Proximal and Distal Entry Tears at CT Angiography Predict Long-term Clinical Outcomes in Aortic Dissection. Radiol Cardiothorac Imaging 2021; 3:e210029. [PMID: 34934947 DOI: 10.1148/ryct.2021210029] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 07/28/2021] [Accepted: 08/16/2021] [Indexed: 01/16/2023]
Abstract
Purpose To identify entry tear variables that are related to adverse clinical events by using CT angiography (CTA) performed during the subacute phase of aortic dissection. Materials and Methods In this prospective study conducted from January 2000 to December 2013, participants with an aortic dissection with a patent false lumen and no comorbidities underwent CTA during the subacute phase. Participants were followed up for a survival analysis to assess the time to an adverse aortic event (AAE). The maximum aortic diameter (MAD), proximal and distal tear areas and difference between these areas, and partial false-lumen thrombosis were assessed by using Cox regression for adverse events. Results Seventy-two participants (mean age, 55 years ± 12 [standard deviation]; 55 men) were evaluated: 47 were surgically treated (type A aortic dissection) and 25 were medically treated (type B aortic dissection). Twenty-two participants had an AAE manifest during follow-up (9.22 years ± 5.78): There were 18 elective surgeries for aneurysmal degeneration, two emergent surgeries for acute aortic syndrome, and two aortic condition-related deaths. A categorical model composed of genetic aortic disease (GAD) (hazard ratio [HR], 3.4 [95% CI: 1.2, 9.9]; P = .02), MAD greater than 45 mm (HR, 6.1 [95% CI: 2.4, 15.8]; P < .001), and tear dominance (HR, 5.2 [95% CI: 2.1, 13]; P < .001), defined as an absolute tear area difference of greater than 1.2 cm2, was used to stratify participants into three risk groups: low, without any risk factors (57% [41 of 72] and 7% [three of 41] had events); intermediate, with one risk factor (31% [22 of 72] and 50% [11 of 22] had events); and high, with two or more risk factors (13% [nine of 72] and 89% [eight of nine] had events; log rank P < .001). Conclusion Tear dominance demonstrated at CTA performed in the subacute phase of aortic dissection was related to long-term adverse events. Participants without GAD, dominant tears, or MAD greater than 45 mm had conditions that were safely managed with optimal medical treatment and imaging follow-up.Keywords: CT Angiography, Vascular, Aorta, Dissection Supplemental material is available for this article. © RSNA, 2021See also commentary by Fleischmann and Burris in this issue.
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Affiliation(s)
- Hug Cuellar-Calabria
- Departments of Diagnostic Imaging (H.C.C., G.B., A.R., J.R.J., M.E.), Cardiology (J.R.P., G.T., A.S.A., A.E.), Cardiac Surgery (R.R.), Vascular Surgery (S.B.), and Anesthesiology (N.Z.), Hospital Universitari Vall d'Hebron, Passeig de la Vall d'Hebron 119-129, 08035, Barcelona, Spain; Vall d'Hebron Research Institute, Barcelona, Spain (H.C.C., G.B., A.R., J.R.P., G.T., R.R., S.B., N.Z., J.R.J., A.S.A., M.E., A.E.); and Universitat Autònoma de Barcelona, Barcelona, Spain (H.C.C., G.B., A.R., J.R.P., G.T., R.R., S.B., N.Z., J.R.J., A.S.A., M.E., A.E.)
| | - Gemma Burcet
- Departments of Diagnostic Imaging (H.C.C., G.B., A.R., J.R.J., M.E.), Cardiology (J.R.P., G.T., A.S.A., A.E.), Cardiac Surgery (R.R.), Vascular Surgery (S.B.), and Anesthesiology (N.Z.), Hospital Universitari Vall d'Hebron, Passeig de la Vall d'Hebron 119-129, 08035, Barcelona, Spain; Vall d'Hebron Research Institute, Barcelona, Spain (H.C.C., G.B., A.R., J.R.P., G.T., R.R., S.B., N.Z., J.R.J., A.S.A., M.E., A.E.); and Universitat Autònoma de Barcelona, Barcelona, Spain (H.C.C., G.B., A.R., J.R.P., G.T., R.R., S.B., N.Z., J.R.J., A.S.A., M.E., A.E.)
| | - Albert Roque
- Departments of Diagnostic Imaging (H.C.C., G.B., A.R., J.R.J., M.E.), Cardiology (J.R.P., G.T., A.S.A., A.E.), Cardiac Surgery (R.R.), Vascular Surgery (S.B.), and Anesthesiology (N.Z.), Hospital Universitari Vall d'Hebron, Passeig de la Vall d'Hebron 119-129, 08035, Barcelona, Spain; Vall d'Hebron Research Institute, Barcelona, Spain (H.C.C., G.B., A.R., J.R.P., G.T., R.R., S.B., N.Z., J.R.J., A.S.A., M.E., A.E.); and Universitat Autònoma de Barcelona, Barcelona, Spain (H.C.C., G.B., A.R., J.R.P., G.T., R.R., S.B., N.Z., J.R.J., A.S.A., M.E., A.E.)
| | - José Rodríguez-Palomares
- Departments of Diagnostic Imaging (H.C.C., G.B., A.R., J.R.J., M.E.), Cardiology (J.R.P., G.T., A.S.A., A.E.), Cardiac Surgery (R.R.), Vascular Surgery (S.B.), and Anesthesiology (N.Z.), Hospital Universitari Vall d'Hebron, Passeig de la Vall d'Hebron 119-129, 08035, Barcelona, Spain; Vall d'Hebron Research Institute, Barcelona, Spain (H.C.C., G.B., A.R., J.R.P., G.T., R.R., S.B., N.Z., J.R.J., A.S.A., M.E., A.E.); and Universitat Autònoma de Barcelona, Barcelona, Spain (H.C.C., G.B., A.R., J.R.P., G.T., R.R., S.B., N.Z., J.R.J., A.S.A., M.E., A.E.)
| | - Gisela Teixidó
- Departments of Diagnostic Imaging (H.C.C., G.B., A.R., J.R.J., M.E.), Cardiology (J.R.P., G.T., A.S.A., A.E.), Cardiac Surgery (R.R.), Vascular Surgery (S.B.), and Anesthesiology (N.Z.), Hospital Universitari Vall d'Hebron, Passeig de la Vall d'Hebron 119-129, 08035, Barcelona, Spain; Vall d'Hebron Research Institute, Barcelona, Spain (H.C.C., G.B., A.R., J.R.P., G.T., R.R., S.B., N.Z., J.R.J., A.S.A., M.E., A.E.); and Universitat Autònoma de Barcelona, Barcelona, Spain (H.C.C., G.B., A.R., J.R.P., G.T., R.R., S.B., N.Z., J.R.J., A.S.A., M.E., A.E.)
| | - Rafael Rodríguez
- Departments of Diagnostic Imaging (H.C.C., G.B., A.R., J.R.J., M.E.), Cardiology (J.R.P., G.T., A.S.A., A.E.), Cardiac Surgery (R.R.), Vascular Surgery (S.B.), and Anesthesiology (N.Z.), Hospital Universitari Vall d'Hebron, Passeig de la Vall d'Hebron 119-129, 08035, Barcelona, Spain; Vall d'Hebron Research Institute, Barcelona, Spain (H.C.C., G.B., A.R., J.R.P., G.T., R.R., S.B., N.Z., J.R.J., A.S.A., M.E., A.E.); and Universitat Autònoma de Barcelona, Barcelona, Spain (H.C.C., G.B., A.R., J.R.P., G.T., R.R., S.B., N.Z., J.R.J., A.S.A., M.E., A.E.)
| | - Sergi Bellmunt
- Departments of Diagnostic Imaging (H.C.C., G.B., A.R., J.R.J., M.E.), Cardiology (J.R.P., G.T., A.S.A., A.E.), Cardiac Surgery (R.R.), Vascular Surgery (S.B.), and Anesthesiology (N.Z.), Hospital Universitari Vall d'Hebron, Passeig de la Vall d'Hebron 119-129, 08035, Barcelona, Spain; Vall d'Hebron Research Institute, Barcelona, Spain (H.C.C., G.B., A.R., J.R.P., G.T., R.R., S.B., N.Z., J.R.J., A.S.A., M.E., A.E.); and Universitat Autònoma de Barcelona, Barcelona, Spain (H.C.C., G.B., A.R., J.R.P., G.T., R.R., S.B., N.Z., J.R.J., A.S.A., M.E., A.E.)
| | - Naoufal Zebdi
- Departments of Diagnostic Imaging (H.C.C., G.B., A.R., J.R.J., M.E.), Cardiology (J.R.P., G.T., A.S.A., A.E.), Cardiac Surgery (R.R.), Vascular Surgery (S.B.), and Anesthesiology (N.Z.), Hospital Universitari Vall d'Hebron, Passeig de la Vall d'Hebron 119-129, 08035, Barcelona, Spain; Vall d'Hebron Research Institute, Barcelona, Spain (H.C.C., G.B., A.R., J.R.P., G.T., R.R., S.B., N.Z., J.R.J., A.S.A., M.E., A.E.); and Universitat Autònoma de Barcelona, Barcelona, Spain (H.C.C., G.B., A.R., J.R.P., G.T., R.R., S.B., N.Z., J.R.J., A.S.A., M.E., A.E.)
| | - José Reyes-Juárez
- Departments of Diagnostic Imaging (H.C.C., G.B., A.R., J.R.J., M.E.), Cardiology (J.R.P., G.T., A.S.A., A.E.), Cardiac Surgery (R.R.), Vascular Surgery (S.B.), and Anesthesiology (N.Z.), Hospital Universitari Vall d'Hebron, Passeig de la Vall d'Hebron 119-129, 08035, Barcelona, Spain; Vall d'Hebron Research Institute, Barcelona, Spain (H.C.C., G.B., A.R., J.R.P., G.T., R.R., S.B., N.Z., J.R.J., A.S.A., M.E., A.E.); and Universitat Autònoma de Barcelona, Barcelona, Spain (H.C.C., G.B., A.R., J.R.P., G.T., R.R., S.B., N.Z., J.R.J., A.S.A., M.E., A.E.)
| | - Augusto Sao-Avilés
- Departments of Diagnostic Imaging (H.C.C., G.B., A.R., J.R.J., M.E.), Cardiology (J.R.P., G.T., A.S.A., A.E.), Cardiac Surgery (R.R.), Vascular Surgery (S.B.), and Anesthesiology (N.Z.), Hospital Universitari Vall d'Hebron, Passeig de la Vall d'Hebron 119-129, 08035, Barcelona, Spain; Vall d'Hebron Research Institute, Barcelona, Spain (H.C.C., G.B., A.R., J.R.P., G.T., R.R., S.B., N.Z., J.R.J., A.S.A., M.E., A.E.); and Universitat Autònoma de Barcelona, Barcelona, Spain (H.C.C., G.B., A.R., J.R.P., G.T., R.R., S.B., N.Z., J.R.J., A.S.A., M.E., A.E.)
| | - Manuel Escobar
- Departments of Diagnostic Imaging (H.C.C., G.B., A.R., J.R.J., M.E.), Cardiology (J.R.P., G.T., A.S.A., A.E.), Cardiac Surgery (R.R.), Vascular Surgery (S.B.), and Anesthesiology (N.Z.), Hospital Universitari Vall d'Hebron, Passeig de la Vall d'Hebron 119-129, 08035, Barcelona, Spain; Vall d'Hebron Research Institute, Barcelona, Spain (H.C.C., G.B., A.R., J.R.P., G.T., R.R., S.B., N.Z., J.R.J., A.S.A., M.E., A.E.); and Universitat Autònoma de Barcelona, Barcelona, Spain (H.C.C., G.B., A.R., J.R.P., G.T., R.R., S.B., N.Z., J.R.J., A.S.A., M.E., A.E.)
| | - Arturo Evangelista
- Departments of Diagnostic Imaging (H.C.C., G.B., A.R., J.R.J., M.E.), Cardiology (J.R.P., G.T., A.S.A., A.E.), Cardiac Surgery (R.R.), Vascular Surgery (S.B.), and Anesthesiology (N.Z.), Hospital Universitari Vall d'Hebron, Passeig de la Vall d'Hebron 119-129, 08035, Barcelona, Spain; Vall d'Hebron Research Institute, Barcelona, Spain (H.C.C., G.B., A.R., J.R.P., G.T., R.R., S.B., N.Z., J.R.J., A.S.A., M.E., A.E.); and Universitat Autònoma de Barcelona, Barcelona, Spain (H.C.C., G.B., A.R., J.R.P., G.T., R.R., S.B., N.Z., J.R.J., A.S.A., M.E., A.E.)
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15
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White A, Bozso SJ, Ouzounian M, Chu MW, Moon MC. Acute type A aortic dissection and the consequences of a patent false lumen. JTCVS Tech 2021; 9:1-8. [PMID: 34647041 PMCID: PMC8500985 DOI: 10.1016/j.xjtc.2021.05.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 05/03/2021] [Indexed: 11/15/2022] Open
Affiliation(s)
- Abigail White
- Division of Cardiac Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - Sabin J. Bozso
- Division of Cardiac Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - Maral Ouzounian
- Division of Cardiac Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Michael W.A. Chu
- Division of Cardiac Surgery, Western University, London, Ontario, Canada
| | - Michael C. Moon
- Division of Cardiac Surgery, University of Alberta, Edmonton, Alberta, Canada
- Address for reprints: Michael C. Moon, MD, Division of Cardiac Surgery, Mazankowski Alberta Heart Institute, Department of Surgery, University of Alberta, 8602 112 St NW, Edmonton, Alberta T6G 2E1, Canada.
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16
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Liu J, Yan C, Li L, Feng H, Xie S, Zhang G, Cheng W, Guo M, Liu M. Extended Stent Coverage Decreases Distal Aortic Segmental Enlargement After the Endovascular Repair of Acute Complicated Type B Aortic Dissection: A Multi-Center Retrospective Study of 814 Patients. J Endovasc Ther 2021; 29:96-108. [PMID: 34399592 DOI: 10.1177/15266028211036479] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
PURPOSE This study aimed to investigate the effect of distal aortic segmental enlargement (DASE) after thoracic endovascular aortic repair for complicated type B aortic dissection (cTBAD). MATERIALS AND METHODS From March 2003 to October 2018, 814 patients with acute cTBAD from 5 medical centers were retrospectively identified. DASE is indicated as the enlargement of distal aortic segmental volume ≥1.6 fold of the preoperative volume compared with the most recent postoperative computed tomography angiography (CTA) scan. Of these patients, 635 (78%) were identified as non-DASE, and 179 (22%) were identified as DASE. Competing risk analysis was performed to compare late death and distal aortic reintervention between the groups. The morphological variables and false lumen thrombosis at 7 aortic levels were measured based on the preoperative CTA and the most recent CTA. Univariate and multivariate Cox regression analyses were used to assess the independent predictors of DASE. RESULTS The mean follow-up time of the entire cohort was 5.6 years (interquartile range: 2.4-8.3 years). There were total of 208 late deaths, including 94 (14.8%) deaths in non-DASE group versus 114 (63.7%) deaths in the DASE group. Distal aortic reintervention was observed in 89 patients, with 43(6.7%) in the non-DASE group versus 46 (25.7%) in the DASE group. The cumulative incidence of late death and distal aortic reintervention were significantly higher in the DASE than in the non-DASE group (p<0.001). In morphological analysis, significant incomplete false lumen thrombosis was observed in all distal aortic segments above the aortic level of celiac artery (p<0.01). According to multivariate analysis, the Marfan syndrome, stent coverage to the level of diaphragm and the level of celiac artery were independent predictors of the DASE (p<0.001). Patients with extended stent coverage to the level of celiac artery have shown a lower incidence of DASE (p<0.010). CONCLUSION Compared with the non-DASE group, patients with DASE demonstrated a higher rate of late death and distal aortic reintervention. For the cTBAD population, extended stent-graft coverage to the aortic section between diaphragm and celiac artery might serve as a "cost-efficient" cutoff point aiming to reduce the risk of DASE.
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Affiliation(s)
- Junjun Liu
- Department of Vascular Surgery, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Chaojun Yan
- Department of Cardiac Surgery, The Southwest Hospital Affiliated to Army Medical University (Third Military Medical University), Chongqing, China
| | - Lubin Li
- Department of Vascular Surgery, Yantai Yuhuangding Hospital, Yantai, China
| | - Hai Feng
- Department of Vascular Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Shengmao Xie
- Department of Critical Care Medicine, The 969th Hospital of the Joint Logistics Support Force of PLA, Huhehaote, China
| | - Guohui Zhang
- Department of Dermatology & STD, Nancheng People's Hospital, Fuzhou, China
| | - Wei Cheng
- Department of Cardiac Surgery, The Southwest Hospital Affiliated to Army Medical University (Third Military Medical University), Chongqing, China
| | - Mingjin Guo
- Department of Vascular Surgery, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - MingYuan Liu
- Department of Vascular Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing, China.,Department of Vascular Surgery, Peking University People's Hospital, Beijing, China
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17
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Leo E, Molinari ACL, Ferraresi M, Rossi G. Short Term Outcomes of Distal Extended EndoVascular Aortic Repair (DEEVAR) Petticoat in Acute and Subacute Complicated Type B Aortic Dissection. Eur J Vasc Endovasc Surg 2021; 62:569-574. [PMID: 34301462 DOI: 10.1016/j.ejvs.2021.05.044] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 05/07/2021] [Accepted: 05/29/2021] [Indexed: 01/26/2023]
Abstract
OBJECTIVE The aim of this study was to evaluate the peri-operative and short term results of institutional experience with the Distal Extended EndoVascular Aortic Repair PETTICOAT (DEEVAR PETTICOAT) procedure. METHODS This was a single centre, observational study. From January 2015 to December 2019, 53 patients were admitted to the institution for treatment of acute and subacute complicated type B aortic dissection. Among them, data on 16 patients deemed suitable for a PETTICOAT procedure extended at infrarenal and iliac level by means of a bifurcated endograft were prospectively collected. Patients with persistent pain, visceral or lower limb malperfusion, true lumen collapse, and distal extension with computed tomography angiography (CTA) evidence of entry tears in the infrarenal or iliac zone were included. A CTA scan was performed in all patients at the baseline, before hospital discharge and then at six and 12 months post-operatively to assess aortic remodelling. Complete aortic remodelling was defined as stable aortic size (maximum enlargement < 5 mm) with complete true lumen re-expansion and complete false lumen exclusion or disappearance. RESULTS Technical success was obtained in all patients. One patient (7%) had intra-operative infrarenal aortic rupture during balloon dilation of the distal end of the bare stent, successfully treated by deployment of a bifurcated endograft. Additional covered stenting of the visceral arteries was necessary in nine patients (56%) and malperfusion resolved immediately in all cases. There were no spinal cord ischaemia or other peri-procedural complications, and no post-operative death, stroke, paraplegia/paraparesis, or acute renal failure was observed. Follow up ranged from one month to 24 months (median 7.5 months). One patient (7%) with a history of drug abuse died from sepsis. At the last CTA check, all patients showed complete remodelling of the thoraco-abdominal aorta and iliac arteries without vessel enlargement. CONCLUSION The present findings suggest that the DEEVAR PETTICOAT procedure provides effective sealing of all distal tears without increased risk of major peri-procedural complications. Further studies with larger number of patients and longer follow up are needed to confirm the safety and durability of this technique.
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Affiliation(s)
- Enrico Leo
- Division of Vascular Surgery, Department of Cardiovascular Diseases, A. Manzoni Hospital, Lecco, Italy.
| | - Alessandro C L Molinari
- Division of Vascular Surgery, Department of Cardiovascular Diseases, A. Manzoni Hospital, Lecco, Italy
| | - Marco Ferraresi
- Postgraduate School of Vascular Surgery, University of Milan, Milan, Italy
| | - Giovanni Rossi
- Division of Vascular Surgery, Department of Cardiovascular Diseases, A. Manzoni Hospital, Lecco, Italy
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Liu Y, Zhang B, Liang S, Dun Y, Wang L, Gao H, Ren J, Guo H, Sun X. Impact of body mass index on early and mid-term outcomes after surgery for acute Stanford type A aortic dissection. J Cardiothorac Surg 2021; 16:179. [PMID: 34158094 PMCID: PMC8220728 DOI: 10.1186/s13019-021-01558-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Accepted: 06/07/2021] [Indexed: 11/10/2022] Open
Abstract
Background Obesity is dramatically increasing worldwide, and more obese patients may develop aortic dissection and present for surgical repair. The study aims to analyse the impact of body mass index (BMI) on surgical outcomes in patients with acute Stanford type A aortic dissection (ATAAD). Methods From January 2017 to June 2019, the clinical data of 268 ATAAD patients in a single centre were retrospectively reviewed. They were divided into three groups based on the BMI: normal weight (BMI 18.5 to < 25 kg/m2, n = 110), overweight (BMI 25 to < 30 kg/m2, n = 114) and obese (BMI ≥30 kg/m2, n = 44). Results There was no statistical difference among the three groups in terms of the composite adverse events including 30-day mortality, stroke, paraplegia, renal failure, hepatic failure, reintubation or tracheotomy and low cardiac output syndrome (20.9% vs 21.9% vs 18.2% for normal, overweight and obese, respectively; P = 0.882). No significant difference was found in the mid-term survival among the three groups. The proportion of prolonged ventilation was highest in the obese group followed by the overweight and normal groups (59.1% vs 45.6% vs 34.5%, respectively; P = 0.017). Multivariable logistic regression analysis suggested that BMI was not associated with the composite adverse events, while BMI ≥30 kg/m2 was an independent risk factor for prolonged ventilation (OR 2.261; 95% CI 1.056–4.838; P = 0.036). Conclusions BMI had no effect on the early major adverse outcomes and mid-term survival after surgery for ATAAD. Satisfactory surgical outcomes can be obtained in patients with ATAAD at all weights.
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Affiliation(s)
- Yanxiang Liu
- Department of Vascular Surgery, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Centre for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No.167 North Lishi Road, Xicheng District, Beijing, 100037, China
| | - Bowen Zhang
- Department of Vascular Surgery, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Centre for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No.167 North Lishi Road, Xicheng District, Beijing, 100037, China
| | - Shenghua Liang
- Department of Vascular Surgery, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Centre for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No.167 North Lishi Road, Xicheng District, Beijing, 100037, China
| | - Yaojun Dun
- Department of Vascular Surgery, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Centre for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No.167 North Lishi Road, Xicheng District, Beijing, 100037, China
| | - Luchen Wang
- Department of Vascular Surgery, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Centre for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No.167 North Lishi Road, Xicheng District, Beijing, 100037, China
| | - Haoyu Gao
- Department of Vascular Surgery, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Centre for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No.167 North Lishi Road, Xicheng District, Beijing, 100037, China
| | - Jie Ren
- Department of Vascular Surgery, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Centre for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No.167 North Lishi Road, Xicheng District, Beijing, 100037, China
| | - Hongwei Guo
- Department of Vascular Surgery, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Centre for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No.167 North Lishi Road, Xicheng District, Beijing, 100037, China
| | - Xiaogang Sun
- Department of Vascular Surgery, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Centre for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No.167 North Lishi Road, Xicheng District, Beijing, 100037, China.
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Li D, Yuan D, Peng L, Zheng T, Fan Y. The characteristics of distal tears affect false lumen thrombosis rate after thoracic endovascular aortic repair for acute type B dissection. Interact Cardiovasc Thorac Surg 2021; 33:755-762. [PMID: 34125231 DOI: 10.1093/icvts/ivab166] [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: 12/07/2020] [Revised: 01/25/2021] [Accepted: 05/03/2021] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVES A low false lumen thrombosis rate (FLTR) is common in patients with type B aortic dissection after they have undergone thoracic endovascular aortic repair, which indicates a poor long-term prognosis. This study aimed to establish a quantitative linear regression model to predict false lumen (FL) thrombosis accurately using morphological parameters. METHODS In this retrospective study, we included 59 patients diagnosed with acute type B aortic dissection between 2014 and 2017. Morphological parameters were measured. Univariable and multivariable linear regression analyses were performed, and a linear regression model relating FLTR with the number of re-entry tears was proposed. Ten patients were further chosen to validate the linear relationship, and idealized aortic dissection models were adopted for haemodynamic analysis. RESULTS Only the total area and number of re-entry tears were negatively correlated with FL thrombosis (P < 0.001). Moreover, based on the univariable regression, the number of re-entry tears played a more crucial role in FLTR (R2 = 0.509 vs R2 = 0.298), and the linear relationship model was created as follows: thrombosis rate (%) = -11.25 × distal tear number + 105.24. This model was perfectly matched in 10 patients (concordance correlation coefficient = 0.880, P = 0.947). Moreover, when the total area of re-entry tears was constant, the net blood flow increased rapidly with an increase in the tear count. CONCLUSIONS The number of re-entry tears could be a crucial related factor of FL thrombosis; the larger the number of re-entry tears is, the lower the possibility of thrombosis is.
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Affiliation(s)
- Da Li
- Department of Applied Mechanics, Sichuan University, Chengdu, China
| | - Ding Yuan
- Department of Vascular Surgery of West China Hospital, Sichuan University, Chengdu, China
| | - Liqing Peng
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, China
| | - Tinghui Zheng
- Department of Applied Mechanics, Sichuan University, Chengdu, China
| | - Yubo Fan
- Beijing Advanced Innovation Center of Biomedical Engineering, Key Laboratory for Biomechanics and Mechanobiology of Ministry of Education, School of Biological Science and Medical Engineering, Beihang University, Beijing, China
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20
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Zhou M, Shi Z, Li X, Cai L, Ding Y, Si Y, Deng H, Fu W. Prediction of Distal Aortic Enlargement after Proximal Repair of Aortic Dissection Using Machine Learning. Ann Vasc Surg 2021; 75:332-340. [PMID: 33823266 DOI: 10.1016/j.avsg.2021.02.039] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 05/28/2020] [Accepted: 02/08/2021] [Indexed: 11/15/2022]
Abstract
OBJECTIVES This study aimed to construct a risk prediction model for distal aortic enlargement in patients with type B aortic dissection (TBAD) treated with proximal thoracic endovascular aortic repair (TEVAR). METHODS From June 2010 to June 2016, patients with TBAD who underwent proximal TEVAR were retrospectively analyzed. A total of 38 clinical and imaging variables were collected. Univariable logistic regression was conducted to explore potential risk factors associated with distal aortic enlargement. Elastic net regression was employed to select significantly influential variables. Then, machine learning algorithms (logistic regression (LR), artificial neutral network (ANN), random forest and support vector machine) were applied to build risk prediction models. The area under the receiver operating characteristic curve (AUC), sensitivity and specificity were used to evaluate the performance of these models. RESULTS A total of 503 patients were enrolled in this study. During the follow-up, 105 (20.9%) patients were identified as having distal aortic enlargement, and 69 (13.7%) patients were found to have distal aortic aneurysm formation. Five patients were identified with aortic rupture. True lumen collapse and multi-false lumens were two potential risk factors for distal aortic enlargement after proximal repair of TBAD. The LR model performed the best in predicting distal aortic enlargement, with the highest sensitivity (96.7%) and an AUC of 0.773. The best model for predicting distal aneurysm formation was the ANN model, which yielded the highest AUC (0.876) and a specificity of 79.1%. CONCLUSIONS Machine learning approaches can produce accurate predictions of distal aortic enlargement after proximal repair of TBAD, which potentially benefits subsequent management.
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Affiliation(s)
- Min Zhou
- Department of Vascular Surgery, Institute of Vascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Zhenyu Shi
- Department of Vascular Surgery, Institute of Vascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Xu Li
- Department of Vascular Surgery, Institute of Vascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Liang Cai
- Department of Vascular Surgery, Institute of Vascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Yong Ding
- Department of Vascular Surgery, Institute of Vascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Yi Si
- Department of Vascular Surgery, Institute of Vascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Hongwen Deng
- Department of Global Biostatistics and Data Science, Center for Bioinformatics and Genomics, School of Public Health and Tropical Medicine, Tulane University, New Orleans, Los Angeles
| | - Weiguo Fu
- Department of Vascular Surgery, Institute of Vascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, China.
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21
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Li D, Zheng T, Liu Z, Li Y, Yuan D, Fan Y. Influence of Distal Re-entry Tears on False Lumen Thrombosis After Thoracic Endovascular Aortic Repair in Type B Aortic Dissection Patients: A Computational Fluid Dynamics Simulation. Cardiovasc Eng Technol 2021; 12:426-437. [PMID: 33768445 DOI: 10.1007/s13239-021-00532-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Accepted: 03/05/2021] [Indexed: 02/05/2023]
Abstract
PURPOSE Distal re-entry tears play a significant role in false lumen (FL) thrombosis, which will strongly affect the postoperative long-term survival of patients with type B aortic dissection (TBAD) after thoracic endovascular aortic repair (TEVAR). This study aimed to investigate the influence of a peculiar morphological parameter of the residual re-entry tears in TBAD patients after TEVAR on long-term FL thrombosis using the computational fluid dynamics. METHODS Ideal population-based three-dimensional models of post-operative TBAD were established. Numerical simulation was performed to investigate the hemodynamic differences caused by different tear features, including the tear count, the maximum distance between tears, and the tear area. RESULTS Although the low relative residence time (RRT) area did not change significantly when the tear distance was fixed, the area of oscillatory shear index (OSI) > 0.45 and endothelial cell activation potential (ECAP) > 1.5 decreased significantly with the tear count and area increased and a dramatic increase in blood flow into the FL was also observed. When tear count and total area were fixed, for each 10-mm increase in the maximum distance between tears, the area of low RRT in the FL increased significantly, while the average pressure difference increased by 10.85%. CONCLUSION The different morphology of the re-entry tears had different effects on the thrombosis-related hemodynamic parameters in FL following TEVAR. and the number of re-entry tears was most crucial to the potential thrombosis in the post-TEVAR FL of TBAD patients.
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Affiliation(s)
- Da Li
- Department of Applied Mechanics, Sichuan University, Chengdu, 610065, China
| | - Tinghui Zheng
- Department of Applied Mechanics, Sichuan University, Chengdu, 610065, China
| | - Zhan Liu
- Department of Applied Mechanics, Sichuan University, Chengdu, 610065, China
| | - Yan Li
- Department of Applied Mechanics, Sichuan University, Chengdu, 610065, China
| | - Ding Yuan
- Department Vascular Surgery of West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041, China.
| | - Yubo Fan
- Beijing Advanced Innovation Center of Biomedical Engineering, Key Laboratory for Biomechanics and Mechanobiology of Ministry of Education, School of Biological Science and Medical Engineering, Beihang University, Beijing, 100191, China.
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Zeng Z, Zhao Y, Wu M, Bao X, Li T, Feng J, Feng R, Jing Z. False Lumen Stent-Grafts for Repair of Postdissection Aortic Aneurysms. J Vasc Interv Radiol 2021; 32:703-711. [PMID: 33617958 DOI: 10.1016/j.jvir.2021.01.280] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2020] [Revised: 01/22/2021] [Accepted: 01/30/2021] [Indexed: 11/20/2022] Open
Abstract
PURPOSE To evaluate the safety and efficacy of false lumen (FL) stent-grafts in the treatment of postdissection aortic aneurysms. MATERIALS AND METHODS Eleven patients who underwent endovascular repair using FL stent-grafts from January 2016 to June 2019 were included. Among them, 2 patients had a prior history of type A aortic dissection, whereas 9 had undergone a prior endovascular repair for type B aortic dissection. Computed tomography angiography was performed to evaluate the reintervention and technical success rate, aortic remodeling, and other related aortic complications. RESULTS The mean age of patients was 55.6 ± 10.4 years. Technical success was achieved in all patients, and neither early mortality nor paralysis occurred. In total, 8 visceral branch arteries originating from the FL were reconstructed. The true lumen areas at the celiac axis, superior mesenteric artery, renal artery, and abdominal aortic bifurcation were significantly increased from 230.1 mm2 to 312.3 mm2, 212.1 mm2 to 277.5 mm2, 209.1 mm2 to 291.6 mm2, and 214.4 mm2 to 300.6 mm2, respectively (P < .05). The total diameter of the aorta at the 4 designated levels was stable or had shrunk in all patients. At a mean follow-up of 18.9 ± 7.6 months, 1 patient received re-intervention owing to iliac stent-graft occlusion. No aortic-related mortality occurred. CONCLUSIONS FL stent-grafts can safely and effectively treat patients with postdissection aortic aneurysms. This strategy can be used to promote thrombosis of the FL and aortic remodeling. A larger sample and an extended follow-up period are needed to produce more conclusive results.
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Affiliation(s)
- Zhaoxiang Zeng
- Department of Vascular Surgery, Changhai Hospital, Navy Medical University, Shanghai, P.R. China
| | - Yuxi Zhao
- Department of Vascular Surgery, Changhai Hospital, Navy Medical University, Shanghai, P.R. China
| | - Mingwei Wu
- Department of Vascular Surgery, Changhai Hospital, Navy Medical University, Shanghai, P.R. China
| | - Xianhao Bao
- Department of Vascular Surgery, Changhai Hospital, Navy Medical University, Shanghai, P.R. China
| | - Tao Li
- Department of Vascular Surgery, Changhai Hospital, Navy Medical University, Shanghai, P.R. China
| | - Jiaxuan Feng
- Department of Vascular Surgery, Changhai Hospital, Navy Medical University, Shanghai, P.R. China.
| | - Rui Feng
- Department of Vascular Surgery, Changhai Hospital, Navy Medical University, Shanghai, P.R. China.
| | - Zaiping Jing
- Department of Vascular Surgery, Changhai Hospital, Navy Medical University, Shanghai, P.R. China.
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Iida Y, Hachiya T, Asano R, Inoue S, Fujii S, Sawa S, Shimizu H. Extended thoracic endovascular aortic repair for residual aortic dissection after type A aortic dissection repair. Vascular 2021; 29:826-831. [PMID: 33478338 DOI: 10.1177/1708538120988418] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE We investigated the outcomes of extended coverage of the descending thoracic aorta by thoracic endovascular aortic repair (TEVAR) for residual chronic type B aortic dissection after type A aortic dissection (TAAD) repair. METHODS From November 2015 to August 2020, 36 patients underwent extended TEVAR for residual intimal tear after TAAD repair. We specifically investigated the methods and outcomes of this procedure. RESULTS TEVAR consisted of isolated TEVARs (n = 29), single-vessel debranching TEVAR (6), and two-vessel debranching TEVAR (1). The mean time from TAAD repair to TEVAR was 27 ± 33 months (2-86 months). The TEVAR devices used were Valiant (28 cases), GORETAG (4), Relay plus (2), and TX2 (2). Technical success of TEVAR was 100%. The distal ends of the stent grafts were T 8 (1 case), T 9 (5), T 10 (6), T 11 (9), and T 12 (15), with an average of T 11 ± 1. The average length of hospital stay after TEVAR was 9 ± 3 days (5-17 days). There were no surgical/hospital deaths or complications. The average postoperative follow-up period was 21 ± 15 months without death or reintervention. CONCLUSIONS The short-term outcomes of extended TEVAR for residual chronic type B aortic dissection after TAAD repair were acceptable without perioperative SCI. Aggressive descending thoracic aorta coverage may prevent aortic events, and extended TEVAR may be a preemptive treatment for the downstream aorta. Mid- to long-term results should be clarified.
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Affiliation(s)
- Yasunori Iida
- Department of Cardiovascular Surgery, Saiseikai Yokohamashi Tobu Hospital, Kanagawa, Japan
| | - Takashi Hachiya
- Department of Cardiovascular Surgery, Saiseikai Yokohamashi Tobu Hospital, Kanagawa, Japan
| | - Ryota Asano
- Department of Cardiovascular Surgery, Ogikubo Hospital, Tokyo, Japan
| | - Shinya Inoue
- Department of Cardiovascular Surgery, Kawasaki Municipal Hospital, Kanagawa, Japan
| | - Susumu Fujii
- Department of Cardiovascular Surgery, Ogikubo Hospital, Tokyo, Japan
| | - Shigeharu Sawa
- Department of Cardiovascular Surgery, Ogikubo Hospital, Tokyo, Japan
| | - Hideyuki Shimizu
- Department of Cardiovascular Surgery, Keio University, Tokyo, Japan
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Zeng Z, Zhao Y, Wu M, Bao X, Li T, Feng J, Feng R, Jing Z. Endovascular strategies for post-dissection aortic aneurysm (PDAA). J Cardiothorac Surg 2020; 15:287. [PMID: 33004048 PMCID: PMC7528487 DOI: 10.1186/s13019-020-01331-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Accepted: 09/22/2020] [Indexed: 11/23/2022] Open
Abstract
Residual patent false lumen (FL) after type B aortic dissection (TBAD) repair is independently associated with poor long-term survival. Open surgery and endovascular repair result in good clinical outcomes in patients with AD. However, both treatments focus on proximal dissection but not distal dissection. About 13.4–62.5% of these patients present with different degrees of distal aneurysmal dilatation after primary repair. Although open surgery is the first-choice treatment for post-dissection aortic aneurysm (PDAA), there is a need for high technical demand since open surgery is associated with high mortality and morbidity. As a treatment strategy with minimal invasion, endovascular repair shows early benefits and low morbidity. For PDAA, the narrow true lumen (TL), rigid initial flap and branch arteries originating from FL have increased difficulties in operation. The aim of endovascular treatment is to promote FL thrombosis and aortic remodeling. Endovascular repair includes intervention from FL and TL sides. TL intervention techniques (parallel stent-graft, branched and fenestrated stent-graft among others) have been proven to be safe and effective in PDAA. Other FL intervention techniques that have been used in selected patients include FL embolization and candy-plug techniques. This article introduces available endovascular techniques and their outcomes for the treatment of PDAA.
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Affiliation(s)
- Zhaoxiang Zeng
- Department of Vascular Surgery, Changhai Hospital, Navy Medical University, 168 Changhai Road, Shanghai, 200433, People's Republic of China
| | - Yuxi Zhao
- Department of Vascular Surgery, Changhai Hospital, Navy Medical University, 168 Changhai Road, Shanghai, 200433, People's Republic of China
| | - Mingwei Wu
- Department of Vascular Surgery, Changhai Hospital, Navy Medical University, 168 Changhai Road, Shanghai, 200433, People's Republic of China
| | - Xianhao Bao
- Department of Vascular Surgery, Changhai Hospital, Navy Medical University, 168 Changhai Road, Shanghai, 200433, People's Republic of China
| | - Tao Li
- Department of Vascular Surgery, Changhai Hospital, Navy Medical University, 168 Changhai Road, Shanghai, 200433, People's Republic of China
| | - Jiaxuan Feng
- Department of Vascular Surgery, Changhai Hospital, Navy Medical University, 168 Changhai Road, Shanghai, 200433, People's Republic of China.
| | - Rui Feng
- Department of Vascular Surgery, Changhai Hospital, Navy Medical University, 168 Changhai Road, Shanghai, 200433, People's Republic of China.
| | - Zaiping Jing
- Department of Vascular Surgery, Changhai Hospital, Navy Medical University, 168 Changhai Road, Shanghai, 200433, People's Republic of China.
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25
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Guo W, Rong D, Liu F, Ge Y, Zhang H, Ma X, Xiong J, Jia X, Liu X. Preclinical evaluation of an endovascular sealing device for distal re-entry tears in type B aortic dissection in a porcine model. Int J Cardiol 2020; 313:108-113. [PMID: 32305561 DOI: 10.1016/j.ijcard.2020.04.045] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Revised: 04/01/2020] [Accepted: 04/15/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVES The objective of present study was to evaluate the feasibility and safety of a novel endovascular sealing device for distal re-entry tears in type B aortic dissection in a porcine model. BACKGROUND Distal re-entry tears are a well-recognized risk factor for unfavorable aortic remodeling after thoracic endovascular aortic repair. However, there is currently no device for sealing a distal re-entry tear. METHODS We implanted the ENDOPATCH device (Weiqiang Medical, Hangzhou, China) in 15 pigs (40-50 kg) under angiographic guidance. The device can be retrieved and repositioned with an 8-10 French sheath. All pigs were assessed using angiography before sacrifice 1- (n = 1), 3- (n = 1), and 6 months (n = 13) after implantation, which was followed by gross specimen evaluation and histological examination of harvested tissues. RESULTS The ENDOPATCH device was successfully implanted in all 15 pigs. The mean disk diameter of the implant was 10.3 ± 1.7 mm, and the chosen device was 4.4 ± 0.9 mm larger than the measured maximum diameter of the fistula. No device migration or leakage was observed angiographically, before sacrifice. An organized thrombus on the disk surface was found in the inferior vena cava of one pig. Complete sealing of the fistula was confirmed by gross and microscopic examinations in all pigs. CONCLUSIONS Our results indicated that the ENDOPATCH device is feasible and safe in a porcine model. Human studies are needed to evaluate the safety and efficacy of the ENDOPATCH.
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Affiliation(s)
- Wei Guo
- Department of Vascular and Endovascular Surgery, Chinese PLA General Hospital, Beijing, China.
| | - Dan Rong
- Department of Vascular and Endovascular Surgery, Chinese PLA General Hospital, Beijing, China
| | - Feng Liu
- Department of Vascular and Endovascular Surgery, Chinese PLA General Hospital, Beijing, China
| | - Yangyang Ge
- Department of Vascular and Endovascular Surgery, Chinese PLA General Hospital, Beijing, China
| | - Hongpeng Zhang
- Department of Vascular and Endovascular Surgery, Chinese PLA General Hospital, Beijing, China
| | - Xiaohui Ma
- Department of Vascular and Endovascular Surgery, Chinese PLA General Hospital, Beijing, China
| | - Jiang Xiong
- Department of Vascular and Endovascular Surgery, Chinese PLA General Hospital, Beijing, China
| | - Xin Jia
- Department of Vascular and Endovascular Surgery, Chinese PLA General Hospital, Beijing, China
| | - Xiaoping Liu
- Department of Vascular and Endovascular Surgery, Chinese PLA General Hospital, Beijing, China
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Sharif M, Yap ZJ, Ghazal A, Bashir M, Harky A. Tear Size and Location Influence the Pressure of False Lumen Following Type A Aortic Dissection: Perspective of Current Evidence. Heart Lung Circ 2020; 29:178-187. [DOI: 10.1016/j.hlc.2019.06.715] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2019] [Revised: 04/16/2019] [Accepted: 06/05/2019] [Indexed: 01/16/2023]
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Kim JH, Lee SH, Lee S, Youn YN, Yoo KJ, Joo HC. The Impact of a Reentry Tear After Open Repair of Nonsyndromic Acute Type I Aortic Dissection. Ann Thorac Surg 2019; 110:475-482. [PMID: 31862492 DOI: 10.1016/j.athoracsur.2019.10.062] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Revised: 09/10/2019] [Accepted: 10/02/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND The role of a reentry tear in the descending thoracic aorta (DTA) after repair of acute aortic dissection is not well known. We therefore investigated the impact of reentry tear location on late aorta reintervention and the aortic expansion rate after open repair of acute type I aortic dissection. METHODS We analyzed 309 nonsyndromic acute type I aortic dissection patients who were treated with a repair to the proximal aorta between 1994 and 2017. The locations of reentry tears, identified with predischarge computed tomography, were the proximal DTA in 119 patients (38.5%), distal DTA in 78 (25.2%), and abdominal aorta in 129 (41.7%). Patients who had a proximal DTA reentry tear were defined as the PDR group (119 [38.5%]), and the others were defined as the non-PDR group (190 [61.5%]). RESULTS The 15-year freedom from aorta reintervention was significantly lower in the PDR group (51.5% ± 0.7% vs 90.4% ± 4.4%, P < .001). The aortic expansion rates of the proximal DTA (7.6 ± 16.1 mm/y vs 0.1 ± 2.5 mm/y, P < .001) and distal DTA (6.8 ± 15.5 mm/y vs 0.3 ± 3.1 mm/y, P < .001) were significantly higher in the PDR group. The 15-year freedom from significant aortic expansion was significantly lower in the PDR group (34.6% ± 6.9% vs 83.6% ± 7.9%, P < .001). Multivariate analysis showed that a proximal DTA reentry tear was an independent risk factor for aorta reintervention (hazard ratio, 4.955; 95% confidence interval, 1.691-14.523; P = .004) and significant aortic expansion (HR, 4.214; 95% CI, 1.691-10.498; P = .002). CONCLUSIONS A proximally located DTA reentry tear was associated with an increased risk of late aorta reintervention and distal aortic dilatation.
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Affiliation(s)
- Jung-Hwan Kim
- Division of Cardiovascular Surgery, Department of Thoracic and Cardiovascular Surgery, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Seung Hyun Lee
- Division of Cardiovascular Surgery, Department of Thoracic and Cardiovascular Surgery, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Sak Lee
- Division of Cardiovascular Surgery, Department of Thoracic and Cardiovascular Surgery, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Young-Nam Youn
- Division of Cardiovascular Surgery, Department of Thoracic and Cardiovascular Surgery, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Kyung-Jong Yoo
- Division of Cardiovascular Surgery, Department of Thoracic and Cardiovascular Surgery, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Hyun-Chel Joo
- Division of Cardiovascular Surgery, Department of Thoracic and Cardiovascular Surgery, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea.
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Predictor of false lumen thrombosis after thoracic endovascular aortic repair for type B dissection. J Thorac Cardiovasc Surg 2019; 160:360-367. [PMID: 31558276 DOI: 10.1016/j.jtcvs.2019.07.091] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Revised: 07/06/2019] [Accepted: 07/14/2019] [Indexed: 02/05/2023]
Abstract
OBJECTIVE Thoracic endovascular aortic repair of type B aortic dissection initiates thrombosis in the false lumen, which eventually results in aortic remodeling. We aimed to determine whether the false lumen thrombosis rate (FLTR) after thoracic endovascular aortic repair can be accurately predicted by an index that expresses the degree of aortic arch angulation. METHODS The geometry of 48 patients with acute type B aortic dissection (mean age, 48 years) after thoracic endovascular aortic repair was reconstructed from postoperative computed tomography images. We introduced a novel angle-the degree of question mark (φ)-to indicate the aortic morphology. Moreover, how aortic angulation influenced the FLTR was investigated based on hemodynamic parameters. Finally, a predicted mathematical model relating FLTR to aortic angulation was proposed, and 10 patients were chosen to validate the model. RESULTS The degree of question mark shape was shown to negatively correlate with FLTR (n = 38; P < .001; R = -0.661), and the linear relationship model was created as follows: FLTR (%) = -1.955 × φ + 168.24 (R2 = 0.437; P < .001). In addition, the net flow rate to the false lumen significantly increased with the increase of the degree of the question mark shape of the aorta. Furthermore, the difference and concordance of the proposed prediction model were perfectly validated in the remaining 10 patients using paired-sample t test and the concordance correlation coefficient. CONCLUSIONS The size of the question mark shape may be a good predictor for FLTR of acute type B aortic dissection following thoracic endovascular aortic repair. The higher the degrees of the question mark, the less likely it was to form a complete thrombus.
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Shen Y, Rao W, Liu J, Zhu G, Chen Z, Song C, Lu Q, Jing Z. A Promising Treatment of Distal Entry Tears Located in Branched Area of Abdominal Aorta With Coil-Stent Tear Occlusion Device: an Animal Experiment. J Cardiovasc Transl Res 2019; 12:338-346. [PMID: 30915624 DOI: 10.1007/s12265-019-09869-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Accepted: 01/27/2019] [Indexed: 11/28/2022]
Abstract
This study aims to evaluate the effect of coil-stent tear occlusion device in treating entry tears located in branched area of abdominal aorta. An abdominal aortic dissection animal model was constructed by mesh suturing method. The animal models were treated by the occlusion device and were evaluated by computed tomography angiography (CTA) 1 month later. Eighteen pigs were adopted in the abdominal aortic dissection modeling experiment, two of them died of cardiopulmonary arrest during the operation. Sixteen models survived, two of them were found complete false lumen thrombosis by CTA 3 days after the operation. The false lumen kept patency in the remaining 14 cases which were then implanted with the occlusion device. The procedure was successful in 13 cases except for one. The coil-stent tear occlusion device provides a novel method for tears located in the branched area of abdominal aorta, and is worth of further study.
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Affiliation(s)
- Yu Shen
- Department of Vascular Surgery, Changhai Hospital, Second Military Medical University, 168 Changhai Road, Shanghai, 200433, China
| | - Wenquan Rao
- Department of Vascular Surgery, Changhai Hospital, Second Military Medical University, 168 Changhai Road, Shanghai, 200433, China
| | - Junjun Liu
- Department of Vascular Surgery, The Affiliated Hospital of Qingdao University, 16 Jiangshu Road, Qingdao, 266003, China
| | - Guanglang Zhu
- Department of Vascular Surgery, Changhai Hospital, Second Military Medical University, 168 Changhai Road, Shanghai, 200433, China
| | - Zheng Chen
- Department of Vascular Surgery, Changhai Hospital, Second Military Medical University, 168 Changhai Road, Shanghai, 200433, China
| | - Chao Song
- Department of Vascular Surgery, Changhai Hospital, Second Military Medical University, 168 Changhai Road, Shanghai, 200433, China
| | - Qingsheng Lu
- Department of Vascular Surgery, Changhai Hospital, Second Military Medical University, 168 Changhai Road, Shanghai, 200433, China.
| | - Zaiping Jing
- Department of Vascular Surgery, Changhai Hospital, Second Military Medical University, 168 Changhai Road, Shanghai, 200433, China.
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Hu Z, Zhang M, Li B, Hong J, Wang Z. “Wait and watch” is a rational strategy for treating distal tears of acute aortic dissection. Int J Cardiol 2018; 271:322. [DOI: 10.1016/j.ijcard.2018.05.104] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Accepted: 05/25/2018] [Indexed: 10/28/2022]
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