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Tian Y, Wang C, Xie P. Mid-term outcomes of left subclavian artery revascularization with Castor stent graft in treatment of type B aortic dissection in left subclavian artery. J Interv Med 2023; 6:74-80. [PMID: 37409064 PMCID: PMC10318335 DOI: 10.1016/j.jimed.2023.04.002] [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: 01/13/2023] [Revised: 04/07/2023] [Accepted: 04/09/2023] [Indexed: 07/07/2023] Open
Abstract
Background Here we analyzed mid-term data of thoracic endovascular aneurysm repair (TEVAR) surgery with Castor single-branched stent graft placement for the management of Stanford type B aortic dissection (STBAD) involving the left subclavian artery (LSA). Methods Between April 2014 and February 2019, 32 patients with STBAD involving a Castor single-branched stent graft were included. We analyzed their outcomes, including technical success rate (TSR), surgical duration (SD), presence of ischemia, perioperative complications, LSA patency, and survival rate (SR), using computed tomography angiography and clinical evaluation during mid-term follow-up. Results The mean patient age was 54.63 ± 12.37 years (range, 36-83 years). The TSR was 96.88% (n = 31/32). The mean SD was 87.44 ± 10.89 with a mean contrast volume of 125.31 ± 19.30 mL. No neurological complications or deaths occurred during the study period. The patients had a mean hospital stay of 7.84 ± 3.20 days. At a mean follow-up of 68.78 ± 11.26 months, four non-aortic deaths (12.5%) were observed. The LSA patency rate was 100% (n = 28/28). There was only one case of type I endoleak immediately after surgery (3.12%) (type I from LSA). However, none of the patients experienced type II endoleaks, and there were no cases of retrograde type A aortic dissection or stent graft-driven new distal entry. Finally, all patients exhibited good LSA patency. Conclusion TEVAR using a Castor single-branched stent graft may be a highly feasible and efficient procedure for the management of STBAD involving the LSA.
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Affiliation(s)
- Yu Tian
- Department of Interventional Therapy, Cancer Hospital Chinese Academy of Medical Science, ShenZhen Center, Guangdong Province, China
| | - Chengjie Wang
- Department of Vascular Surgery, Yuhuangding Hospital, Yantai, Shandong Province, China
| | - Peng Xie
- Department of Orthopedics, The 3rd Affiliated Hospital of Shenzhen University, Shenzhen, Guangdong Province, China
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2
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Capoccia M, Sherif MA, Nassef A, Shaw D, Walker P, Evans B, Kaul P, Elmahdy W. Aortic arch surgery for type B aortic dissection: How far should we go? The value of a hybrid approach. Clin Case Rep 2023; 11:e6742. [PMID: 36619481 PMCID: PMC9810843 DOI: 10.1002/ccr3.6742] [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: 08/30/2022] [Revised: 11/21/2022] [Accepted: 12/04/2022] [Indexed: 01/05/2023] Open
Abstract
Traditionally, the management of type B aortic dissection has been the domain of the vascular surgeons. Timing and type of intervention still generate debate. We sought to review our early experience with the treatment of this condition based on a hybrid approach following an aortic multi-disciplinary team meeting involving close cooperation between cardiac surgeons, vascular surgeons, interventional radiologists, vascular anesthetists, and cardiac anesthetists. Four patients (age 41-56 years; 3 males; 1 female) with type B aortic dissection underwent aortic arch surgery through a hybrid approach: one elective procedure consisting of ascending aorta and hemi-arch replacement with debranching followed by thoracic endovascular aortic repair (TEVAR); one redo procedure requiring aortic arch replacement with hybrid frozen elephant trunk; two acute presentations (aortic arch replacement and debranching followed by TEVAR; AVR with ascending aorta, arch, and proximal descending thoracic aorta replacement with conventional elephant trunk and debranching). Deep hypothermic circulatory arrest was required in three patients. Despite respiratory complications and slightly prolonged postoperative course, all patients survived without onset of stroke, paraplegia, malperfusion, endoleak, or need for re-exploration. Follow-up remains satisfactory. Different factors may affect outcome following complex aortic procedures. Nevertheless, close cooperation between cardiac surgeons, vascular surgeons, and interventional radiologists may reduce potential for complications and address aspects that may not be completely within the domain of individual specialists.
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Affiliation(s)
- Massimo Capoccia
- Cardiac Surgery, Yorkshire Heart CentreLeeds Teaching Hospitals NHS TrustLeedsUK
| | - Mohamed Ashur Sherif
- Cardiac Surgery, Yorkshire Heart CentreLeeds Teaching Hospitals NHS TrustLeedsUK
| | - Ahmed Nassef
- Vascular SurgeryLeeds Teaching Hospitals NHS TrustLeedsUK
| | - David Shaw
- Interventional RadiologyLeeds Teaching Hospitals NHS TrustLeedsUK
| | - Paul Walker
- Interventional RadiologyLeeds Teaching Hospitals NHS TrustLeedsUK
| | - Betsy Evans
- Cardiac Surgery, Yorkshire Heart CentreLeeds Teaching Hospitals NHS TrustLeedsUK
| | - Pankaj Kaul
- Cardiac Surgery, Yorkshire Heart CentreLeeds Teaching Hospitals NHS TrustLeedsUK
| | - Walid Elmahdy
- Cardiac Surgery, Yorkshire Heart CentreLeeds Teaching Hospitals NHS TrustLeedsUK
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Chandra VM, Norton EL, Khaja MS, Herrera DG, Williams DM, Yang B. Surgical and endovascular repair for type B aortic dissections with mesenteric malperfusion syndrome: A systematic review of in-hospital mortality. JTCVS OPEN 2022; 12:37-50. [PMID: 36590716 PMCID: PMC9801243 DOI: 10.1016/j.xjon.2022.07.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 07/06/2022] [Accepted: 07/20/2022] [Indexed: 06/17/2023]
Abstract
OBJECTIVES Mesenteric malperfusion is a feared complication of aortic dissection, with high mortality. The purpose of this study was to systematically review in-hospital mortality (IHM) of endovascular and surgical management of acute and chronic Stanford type B aortic dissections (TBAD) complicated by mesenteric malperfusion (MesMP). METHODS A systematic search of English language articles was conducted in relevant databases. Data on patient demographics, procedure details, and survival outcomes were collected. Reports were classified by type of intervention performed. Studies that failed to report patient-level outcomes based on specific intervention performed or IHM were excluded. Retrospective chart review of previously published data from a single institution was also performed to further identify cases of TBAD that were managed endovascularly. The Fisher exact test was performed to determine statistical significance. RESULTS In total, 37 articles were suitable for inclusion in this systematic review, which yielded 149 patients with a median age 55.0 years (interquartile range, 46.5-65 years) and 79% being male. Overall, in-hospital mortality was 12.8% (19/149) and was similar between endovascular and open surgical interventions (13% vs 11%, P = .99). Among endovascular strategies, IHM was greater, although not statistically significant in the thoracic endovascular aortic repair group compared with the fenestration/stenting without thoracic endovascular aortic repair group (24% vs 11%, P = .15). CONCLUSIONS Multiple strategies exist for the management of TBAD with MesMP; however, a majority of cases were managed endovascularly. Despite advances in therapies, mortality remains high at 13%.
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Affiliation(s)
- Vishnu M. Chandra
- Division of Vascular and Interventional Radiology, Department of Radiology & Medical Imaging, University of Virginia Health, Charlottesville, Va
| | - Elizabeth L. Norton
- Division of Cardiothoracic Surgery, Department of Surgery, Emory University, Atlanta, Ga
| | - Minhaj S. Khaja
- Division of Vascular and Interventional Radiology, Department of Radiology & Medical Imaging, University of Virginia Health, Charlottesville, Va
- Division of Vascular and Interventional Radiology, Department of Radiology, University of Michigan, Ann Arbor, Mich
| | - Daniel Giraldo Herrera
- Division of Vascular and Interventional Radiology, Department of Radiology & Medical Imaging, University of Virginia Health, Charlottesville, Va
| | - David M. Williams
- Division of Vascular and Interventional Radiology, Department of Radiology, University of Michigan, Ann Arbor, Mich
| | - Bo Yang
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, Mich
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Langouet Q, Marchand E, Nauta A, Loreille F, Aupart M, Bourguignon T, Martinez R. Initial Study of the Extended STABILISE Technique for Complete Remodeling in Aortic Dissection. Ann Vasc Surg 2022; 86:373-379. [PMID: 35395379 DOI: 10.1016/j.avsg.2022.03.024] [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: 01/07/2022] [Revised: 03/18/2022] [Accepted: 03/21/2022] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Thoracic endovascular aortic repair (TEVAR) is the standard treatment for acute complicated type B aortic dissection (TBAD). However, long-term results reveal that TEVAR does not achieve a complete aortic remodeling and poses a risk of aneurysmal aortic degeneration. Distal reentry treatment at the abdominal level seems to be necessary to obtain a complete remodeling in TBAD. Moreover, it is necessary to treat the aortoiliac bifurcation in patients with persistent true lumen collapse or limb ischemia. METHODS Between January 2018 and October 2019, 11 patients with acute or sub-acute complicated TBAD or non-A non-B aortic dissection were treated in our institution in an endovascular fashion. We performed the stent-assisted balloon-induced intimal disruption and relamination in aortic dissection repair (STABLISE) technique in all cases, but two cases required complementary treatment of the aortoiliac bifurcation with a bifurcated AFX endograft system for limb ischemia due to true lumen collapse. RESULTS Technical success was obtained in all patients. No procedural complications occurred. No postoperative deaths, stroke, paraplegia, mesenteric, or renal ischemia were observed, and no secondary intervention was necessary. Satisfactory aortic remodeling was obtained after the follow-up periods with a 57.5% mean true lumen expansion. CONCLUSION Our initial experience using the extended STABILISE (e-STABILISE) technique using a bifurcated AFX endograft did not result in any postoperative mortality or complications. Without additional data, this technique should be reserved for specific patients who require revascularization of the aortoiliac bifurcation.
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Affiliation(s)
- Quentin Langouet
- Department of Cardio-Vascular and Thoracic Surgery. CHRU Tours, Chambray-lès-Tours, Avenue de la République, Loire Valley. France.
| | - Etienne Marchand
- Department of Cardio-Vascular and Thoracic Surgery. CHRU Tours, Chambray-lès-Tours, Avenue de la République, Loire Valley. France
| | - Anapa Nauta
- Department of Cardio-Vascular and Thoracic Surgery. CHRU Tours, Chambray-lès-Tours, Avenue de la République, Loire Valley. France
| | - Frederic Loreille
- Department of Cardio-Vascular and Thoracic Surgery. CHRU Tours, Chambray-lès-Tours, Avenue de la République, Loire Valley. France
| | - Michel Aupart
- Department of Cardio-Vascular and Thoracic Surgery. CHRU Tours, Chambray-lès-Tours, Avenue de la République, Loire Valley. France
| | - Thierry Bourguignon
- Department of Cardio-Vascular and Thoracic Surgery. CHRU Tours, Chambray-lès-Tours, Avenue de la République, Loire Valley. France
| | - Robert Martinez
- Department of Cardio-Vascular and Thoracic Surgery. CHRU Tours, Chambray-lès-Tours, Avenue de la République, Loire Valley. France
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5
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Costache VS, Meekel JP, Costache A, Melnic T, Bucurenciu C, Chitic A, Candea G, Solomon C, Yeung KK. One-Year Single-Center Results of the Multilayer Flow Modulator Stents for the Treatment of Type B Aortic Dissection. J Endovasc Ther 2020; 28:20-31. [PMID: 32873130 PMCID: PMC7816551 DOI: 10.1177/1526602820950720] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Purpose To report a single-center series of patients with type B aortic dissection treated with the Multilayer Flow Modulator (MFM). Materials and Methods Over a 36-month period, 23 patients (median age 53 years; 20 men) with complicated type B aortic dissections (2 acute, 5 subacute, and 16 chronic) were treated with the MFM. Primary endpoints of rupture or dissection-related death, overall mortality, and reintervention were evaluated using the Kaplan-Meier method; estimates for freedom from the endpoints are reported with the 95% confidence interval (CI). Secondary outcomes included technical success, adverse events, and aortic remodeling. Clinical and imaging data were collected preoperatively, directly postoperatively, and annually to 36 months for analysis using computational fluid dynamics (CFD). Results Initial technical success was 91.3%. The estimates of the endpoints at 12 months were 100% for freedom from rupture or aortic-related death, 95.7% for freedom from overall mortality, and 91.3% for freedom from reintervention. No device-related neurological or systemic complications occurred, and no additional reinterventions were needed during follow-up. A total of 144 branches overstented by the MFM remained patent. Morphologic analysis of the aortic dissection showed progressive true lumen volume increase (75.9%, p<0.001) with concomitant false lumen volume decrease (42.8%, p<0.001); the CFD analyses showed increased laminar flow. Conclusion In the current series, the MFM provided a safe and feasible treatment option for complicated acute, subacute, and chronic type B aortic dissections, with high technical success, low mortality, and active aortic remodeling. Further studies should elucidate the long-term safety of the MFM and its effectiveness in a larger patient cohort.
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Affiliation(s)
- Victor S Costache
- NEXTcardio Project, Lucian Blaga University, Sibiu, Romania.,Cardiovascular Department, Polisano European Hospital, Sibiu, Romania
| | - Jorn P Meekel
- NEXTcardio Project, Lucian Blaga University, Sibiu, Romania.,Department of Vascular Surgery, Amsterdam University Medical Centers, Amsterdam, the Netherlands.,Department of Surgery, Zaans Medisch Centrum, Zaandam, the Netherlands.,Amsterdam Cardiovascular Sciences, VU University Medical Center Amsterdam, the Netherlands
| | - Andreea Costache
- NEXTcardio Project, Lucian Blaga University, Sibiu, Romania.,Cardiovascular Department, Polisano European Hospital, Sibiu, Romania
| | - Tatiana Melnic
- NEXTcardio Project, Lucian Blaga University, Sibiu, Romania.,Cardiovascular Department, Polisano European Hospital, Sibiu, Romania
| | | | - Anca Chitic
- NEXTcardio Project, Lucian Blaga University, Sibiu, Romania.,Cardiovascular Department, Polisano European Hospital, Sibiu, Romania
| | | | - Crina Solomon
- NEXTcardio Project, Lucian Blaga University, Sibiu, Romania
| | - Kak K Yeung
- NEXTcardio Project, Lucian Blaga University, Sibiu, Romania.,Department of Vascular Surgery, Amsterdam University Medical Centers, Amsterdam, the Netherlands.,Amsterdam Cardiovascular Sciences, VU University Medical Center Amsterdam, the Netherlands
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6
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Bavaria JE, Brinkman WT, Hughes GC, Shah AS, Charlton-Ouw KM, Azizzadeh A, White RA. Five-year outcomes of endovascular repair of complicated acute type B aortic dissections. J Thorac Cardiovasc Surg 2020; 163:539-548.e2. [DOI: 10.1016/j.jtcvs.2020.03.162] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Revised: 03/05/2020] [Accepted: 03/16/2020] [Indexed: 11/28/2022]
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7
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Eleshra A, Kölbel T, Panuccio G, Rohlffs F, Debus ES, Tsilimparis N. Endovascular Therapy for Nonischemic vs Ischemic Complicated Acute Type B Aortic Dissection. J Endovasc Ther 2019; 27:145-152. [DOI: 10.1177/1526602819888672] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Purpose: To report a single-center experience with thoracic endovascular aortic repair (TEVAR) for complicated acute type B aortic dissection (cATBAD) comparing patients with vs without end-organ ischemia. Materials and Methods: Between November 2010 and December 2017, 64 patients (mean age 64.8±12.5 years; 49 men) underwent TEVAR for cATBAD. Patients were grouped into 2 cohorts: nonischemic (39, 61%) patients with unrelenting pain, early progressive aortic dilatation, uncontrolled hypertension, or rupture, and ischemic (25, 39%) patients with visceral, renal, lower extremity, or spinal cord hypoperfusion. Results: Mean time from diagnosis to treatment was 7.5 days (range 1–32) in the nonischemic group vs 2.3 days (range 1–14) days in the ischemic group (p=0.007). Fourteen (56%) of 25 ischemic cATBAD patients had stents implanted in the renovascular branch vessels, while 4 (16%) patients had stents implanted in the iliac arteries. When branch vessel cannulation failed, fenestrations were made in the intimal flap to improve perfusion of the involved branch (n=5). In the nonischemic group, 3 arteries were stented owing to atherosclerotic stenosis. Technical success was achieved in 62 (97%) of 64 patients; despite stenting, 2 patients had low renal artery perfusion on final angiography. There were no statistically significant differences in early or late outcomes between the nonischemic vs ischemic cATBAD patients. Six (9%) patients died within 30 days: 2 (5%) in the nonischemic group vs 4 (16%) in the ischemic group. Major complications (1 stroke, 2 cases of paraplegia, 1 retrograde type A dissection, and 1 case of bowel ischemia) occurred only in the nonischemic group. The mean follow-up was 28 months. Late endoleaks were observed in 3 (8%) nonischemic patients and 1 (4%) ischemic patient. Reinterventions were required in 7 (18%) nonischemic patients and 4 (16%) ischemic patients. Conclusion: TEVAR is an effective and safe method of treating cATBAD. Early intervention in ischemic cATBAD may have played a significant role in the lack of significant difference between ischemic and nonischemic cATBAD outcomes. Direct visceral reperfusion through branch vessel stenting during TEVAR may be crucial in achieving good outcomes in ischemic cATBAD.
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Affiliation(s)
- Ahmed Eleshra
- German Aortic Center, University Heart Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Tilo Kölbel
- German Aortic Center, University Heart Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Giuseppe Panuccio
- German Aortic Center, University Heart Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Fiona Rohlffs
- German Aortic Center, University Heart Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - E. Sebastian Debus
- German Aortic Center, University Heart Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Nikolaos Tsilimparis
- German Aortic Center, University Heart Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
- Department of Vascular Surgery, Ludwig-Maximilians-University Hospital, Munich, Germany
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8
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Rong D, Ge Y, Liu J, Liu X, Guo W. Combined proximal descending aortic endografting plus distal bare metal stenting (PETTICOAT technique) versus conventional proximal descending aortic stent graft repair for complicated type B aortic dissections. Cochrane Database Syst Rev 2019; 2019. [PMID: 31684692 PMCID: PMC6820126 DOI: 10.1002/14651858.cd013149.pub2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Aortic dissection is a separation of the aortic wall, caused by blood flowing through a tear in the inner layer of the aorta. Aortic dissection is an infrequent but life-threatening condition. The incidence of aortic dissection is 3 to 6 per 10,000 per year in the Western population, and can be up to 43 per 10,000 per year in the Eastern population. Over 20% of people with an aortic dissection do not reach a hospital alive. After admission, the mortality rates for people with an aortic dissection are between 10% and 20% for those who received endovascular treatment, and between 20% and 30% for those who had open surgery. Thoracic endovascular aortic repair (TEVAR) is the standard endovascular method to treat complicated type B aortic dissection (aortic dissections without involvement of the ascending aorta). Although TEVAR is less invasive than open surgery and has a better long-term aortic remodeling effect than conservative medical treatment, favourable aortic remodelling is usually limited to the thoracic aortic segment. TEVAR cannot be extended into the abdominal aorta because it could cover the ostia of the reno-visceral arteries. Thus, the abdominal aorta is still at risk of progressive aneurysmal degeneration. The PETTICOAT (provisional extension to induce complete attachment) technique, with proximal endograft and distal bare metal stent, was proposed in 2006 to address this issue. The concept of this technique was to implant a distal bare metal stent into the aortic true lumen, distal to the proximal endograft, to stabilize the distal collapsed intimal flap, while allowing blood flow to reno-visceral arteries. Therefore, the PETTICOAT technique was considered to be related to a more extensive aortic remodelling for people with type B aortic dissection, especially in the area of the abdominal aorta. However, it is still unclear whether the PETTICOAT technique is superior to standard TEVAR. OBJECTIVES To assess the effects of combined proximal descending aortic endografting plus distal bare metal stenting versus conventional proximal descending aortic stent graft repair for treating complicated type B aortic dissections. SEARCH METHODS The Cochrane Vascular Information Specialist searched the Cochrane Vascular Specialised Register, Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase and Cumulative Index to Nursing and Allied Health Literature (CINAHL) databases, and the World Health Organization International Clinical Trials Registry Platform and ClinicalTrials.gov trials registers to 5 November 2018. We also undertook reference checking and citation searching to identify additional studies. SELECTION CRITERIA We considered all randomised controlled trials which compared the outcome of complicated type B aortic dissection, when treated by combined proximal descending aortic endografting plus distal bare metal stenting (PETTICOAT technique) versus conventional proximal descending aortic stent graft repair. DATA COLLECTION AND ANALYSIS Two independent review authors assessed all references identified by the Cochrane Vascular Information Specialist. We planned to undertake data collection and analysis in accordance with recommendations described in the Cochrane Handbook for Systematic Reviews of Interventions. MAIN RESULTS We found no trials that met the inclusion criteria for this review. AUTHORS' CONCLUSIONS We identified no randomised controlled trials and therefore cannot draw any definite conclusion on this topic. Evidence from non-randomised studies appears to be favourable in the short-term, for combined proximal descending aortic endografting plus distal bare metal stenting (PETTICOAT technique) to solve the problem of unfavourable distal aortic remodeling. Randomised controlled trials are warranted to provide solid evidence on this topic. Evidence from cohort studies with large sample sizes would also be helpful in guiding clinical practice.
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Affiliation(s)
- Dan Rong
- Chinese PLA General Hospital, Department of Vascular and Endovascular Surgery, No 28, Fuxing Road, Haidian District, Beijing, Beijing, China, 100853
| | - Yangyang Ge
- Chinese PLA General Hospital, Department of Vascular and Endovascular Surgery, No 28, Fuxing Road, Haidian District, Beijing, Beijing, China, 100853
| | - Jie Liu
- Chinese PLA General Hospital, Department of Vascular and Endovascular Surgery, No 28, Fuxing Road, Haidian District, Beijing, Beijing, China, 100853
| | - Xiaoping Liu
- Chinese PLA General Hospital, Department of Vascular and Endovascular Surgery, No 28, Fuxing Road, Haidian District, Beijing, Beijing, China, 100853
| | - Wei Guo
- Chinese PLA General Hospital, Department of Vascular and Endovascular Surgery, No 28, Fuxing Road, Haidian District, Beijing, Beijing, China, 100853
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Norton EL, Williams DM, Kim KM, Khaja MS, Wu X, Patel HJ, Deeb GM, Yang B. Management of acute type B aortic dissection with malperfusion via endovascular fenestration/stenting. J Thorac Cardiovasc Surg 2019; 160:1151-1161.e1. [PMID: 31669033 DOI: 10.1016/j.jtcvs.2019.09.065] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2019] [Revised: 08/30/2019] [Accepted: 09/03/2019] [Indexed: 12/17/2022]
Abstract
OBJECTIVE The study objective was to evaluate the management of malperfusion in acute type B aortic dissection with endovascular fenestration/stenting. METHODS From 1996 to 2018, 182 patients with an acute type B aortic dissection underwent fenestration/stenting for suspected malperfusion based on imaging, clinical manifestations, and laboratory findings. Data were obtained from medical record review and the National Death Index database. RESULTS The median age of patients was 55 years. Signs of malperfusion included abdominal pain (61%), lower-extremity weakness (27%), nonpalpable lower-extremity pulses (24%), and abnormal lactate, creatinine, liver enzymes, and creatine kinase levels. Confirmed hemodynamically significant malperfusion affected the spinal cord (2.7%), celiac (24%), superior mesenteric (40%), renal (51%), and iliofemoral (43%) arterial distributions. Of the 182 patients, 99 (54%) underwent aortic fenestration/stenting, 108 (59%) had 1 or multi-branch vessel fenestration/stenting, 5 (2.7%) had concomitant thoracic endovascular aortic repair, 17 (9.3%) had additional thrombolysis or thromboembolectomy, and 48 (26%) received no intervention. After fenestration/stenting, 24 patients (13%) required additional procedures for necrotic bowel or limb and 9 patients (4.9%) had subsequent aortic repair (thoracic endovascular aortic repair, open repair) before discharge. The new-onset paraplegia was 0%. The in-hospital mortality was 7.7% over 20+ years and 0% in the last 8 years. The 5- and 10-year survivals were 72% and 49%, respectively. The significant risk factors for late mortality were age and acute paralysis (hazard ratio, 3.5; both P < .0001). Given death as a competing factor, the 5- and 10-year cumulative incidence of reintervention was 21% and 31% for distal aortic pathology, respectively. CONCLUSIONS Patients with acute type B aortic dissection with malperfusion can be managed with endovascular fenestration/stenting with excellent short- and long-term outcomes. This approach is particularly helpful to patients with static malperfusion of aortic branch vessels.
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Affiliation(s)
| | | | - Karen M Kim
- Department of Cardiac Surgery, Michigan Medicine, Ann Arbor, Mich
| | - Minhaj S Khaja
- Department of Radiology, Michigan Medicine, Ann Arbor, Mich
| | - Xiaoting Wu
- Department of Cardiac Surgery, Michigan Medicine, Ann Arbor, Mich
| | - Himanshu J Patel
- Department of Cardiac Surgery, Michigan Medicine, Ann Arbor, Mich
| | - G Michael Deeb
- Department of Cardiac Surgery, Michigan Medicine, Ann Arbor, Mich
| | - Bo Yang
- Department of Cardiac Surgery, Michigan Medicine, Ann Arbor, Mich.
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Chino S, Kato N, Nakajima K, Hashimoto T, Higashigawa T, Ouchi T, Kato H, Yamamoto N, Ito H, Maze Y, Tokui T, Sakuma H. Thoracic endovascular aortic repair for the treatment of ruptured acute type B aortic dissection. Jpn J Radiol 2019; 37:321-327. [DOI: 10.1007/s11604-019-00813-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Accepted: 01/18/2019] [Indexed: 11/27/2022]
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11
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Rong D, Ge Y, Liu J, Liu X, Guo W. Combined proximal descending aortic endografting plus distal bare metal stenting versus conventional proximal descending aortic stent graft repair for complicated type B aortic dissections. Cochrane Database Syst Rev 2018. [DOI: 10.1002/14651858.cd013149] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Dan Rong
- Chinese PLA General Hospital; Department of Vascular and Endovascular Surgery; No 28, Fuxing Road Haidian District Beijing Beijing China 100853
| | - Yangyang Ge
- Chinese PLA General Hospital; Department of Vascular and Endovascular Surgery; No 28, Fuxing Road Haidian District Beijing Beijing China 100853
| | - Jie Liu
- Chinese PLA General Hospital; Department of Vascular and Endovascular Surgery; No 28, Fuxing Road Haidian District Beijing Beijing China 100853
| | - Xiaoping Liu
- Chinese PLA General Hospital; Department of Vascular and Endovascular Surgery; No 28, Fuxing Road Haidian District Beijing Beijing China 100853
| | - Wei Guo
- Chinese PLA General Hospital; Department of Vascular and Endovascular Surgery; No 28, Fuxing Road Haidian District Beijing Beijing China 100853
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Riambau V, Böckler D, Brunkwall J, Cao P, Chiesa R, Coppi G, Czerny M, Fraedrich G, Haulon S, Jacobs M, Lachat M, Moll F, Setacci C, Taylor P, Thompson M, Trimarchi S, Verhagen H, Verhoeven E, ESVS Guidelines Committee, Kolh P, de Borst G, Chakfé N, Debus E, Hinchliffe R, Kakkos S, Koncar I, Lindholt J, Vega de Ceniga M, Vermassen F, Verzini F, Document Reviewers, Kolh P, Black J, Busund R, Björck M, Dake M, Dick F, Eggebrecht H, Evangelista A, Grabenwöger M, Milner R, Naylor A, Ricco JB, Rousseau H, Schmidli J. Editor's Choice – Management of Descending Thoracic Aorta Diseases. Eur J Vasc Endovasc Surg 2017; 53:4-52. [DOI: 10.1016/j.ejvs.2016.06.005] [Citation(s) in RCA: 598] [Impact Index Per Article: 85.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
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Torsello GF, Austermann M, Van Aken HK, Torsello GB, Panuccio G. Initial clinical experience with the Zenith alpha stent-graft. J Endovasc Ther 2016; 22:153-9. [PMID: 25809352 DOI: 10.1177/1526602815573239] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE To assess safety and short-term efficacy of endovascular repair of the thoracic aorta with the new Zenith Alpha stent-graft. METHODS Between August 2010 and May 2014, 33 patients (21 men; mean age 73.2±9.0 years) were treated Zenith Alpha stent-graft (group ZA). Outcomes of this group were compared with those of 34 patients (25 men; mean age 70.3±8.5 years) treated contemporaneously with the Zenith TX-2 for the same pathologies (group TX). The primary outcome measure was technical success. Data on iliac tortuosity, minimum access vessel diameter, and previous unsuccessful treatment with other endografts was also recorded. RESULTS Technical success was 93.9% in group ZA and 91.2% in group TX (p=0.67). There was no case of surgical death or conversion to open repair in either group. Two (6%) type I endoleaks occurred in group ZA and 3 (9%) in group TX (p=0.67). Three patients died within 30 days in group ZA vs. none in group TX (p=0.07). Mean minimum access vessel diameter was significantly smaller (5.07 vs. 6.65 mm, p=0.002) and iliac tortuosity indices significantly higher in group ZA (1.34 vs. 1.25, p=0.02). Access vessel complications occurred in 1 (3%) patient in group ZA and 4 (12%) patients in group TX (p=0.17). Significantly more patients in group ZA (6, 18%) were unsuccessfully treated previously with other endografts vs. none in group TX (p=0.01). CONCLUSION The new Zenith Alpha appears to be equally as safe and efficacious as the Zenith TX-2 while being used in patients with demanding access vessel morphology.
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Affiliation(s)
- Giovanni F Torsello
- Westphalian Center for Radiology, Münster, Germany St. Franziskus Hospital and University Clinic of Münster, Germany Department of Anesthesiology, Intensive Care and Pain Therapy, University Clinic of Münster, Germany
| | | | - Hugo K Van Aken
- Department of Anesthesiology, Intensive Care and Pain Therapy, University Clinic of Münster, Germany
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Zhang T, Jiang W, Lu H, Liu J. Thoracic Endovascular Aortic Repair Combined with Assistant Techniques and Devices for the Treatment of Acute Complicated Stanford Type B Aortic Dissections Involving Aortic Arch. Ann Vasc Surg 2016; 32:88-97. [DOI: 10.1016/j.avsg.2015.10.030] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2015] [Revised: 08/30/2015] [Accepted: 10/06/2015] [Indexed: 01/03/2023]
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15
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Bavaria JE, Brinkman WT, Hughes GC, Khoynezhad A, Szeto WY, Azizzadeh A, Lee WA, White RA. Outcomes of Thoracic Endovascular Aortic Repair in Acute Type B Aortic Dissection: Results From the Valiant United States Investigational Device Exemption Study∗. Ann Thorac Surg 2015. [DOI: 10.1016/j.athoracsur.2015.03.108] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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16
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Lu T, Fischer UM, Marco RA, Naoum JJ, Reardon MJ, Lumsden AB, Blackmon SH, Davies MG. Case Report: En Bloc Resection of Pancoast Tumor with Adjuvant Aortic Endograft and Chemoradiation. Methodist Debakey Cardiovasc J 2015; 11:140-4. [PMID: 26306134 DOI: 10.14797/mdcj-11-2-140] [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: 11/08/2022] Open
Abstract
"Pancoast" tumors frequently require a multidisciplinary approach to therapy and are still associated with high morbidity and mortality. Due to their sensitive anatomic location, complex resections and chemoradiation regimens are typically required for treatment. Those with signs of aortic invasion pose an even greater challenge, given the added risks of cardiopulmonary bypass for aortic resection and interposition. Placement of an aortic endograft can facilitate resection if the tumor is in close proximity to or is invading the aorta. Prophylactic endografting to prevent radiation-associated aortic rupture has also been described. This case describes a 60-year-old female who presented with a stage IIIa left upper lobe undifferentiated non-small-cell carcinoma encasing the subclavian artery with thoracic aorta and bony invasion. Following carotid-subclavian bypass with Dacron, en bloc resection of the affected lung, ribs, and vertebral bodies was performed. The aorta was prophylactically reinforced with a Gore TAG thoracic endograft prior to adjuvant chemoradiation. The patient remains disease-free at more than 5 years follow-up after completing her treatment course. Endovascular stenting with subsequent chemoradiation may prove to be a viable alternative to palliation or open operative management and prevention of aortic injury during tumor resection and/or adjuvant therapy in select patients with aortic involvement.
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Affiliation(s)
- Tony Lu
- Houston Methodist DeBakey Heart& Vascular Center, Houston Methodist Hospital, Houston, Texas
| | - Uwe M Fischer
- Houston Methodist DeBakey Heart& Vascular Center, Houston Methodist Hospital, Houston, Texas
| | - Rex A Marco
- The University of Texas Medical School at Houston, Houston, Texas
| | - Joseph J Naoum
- Houston Methodist DeBakey Heart& Vascular Center, Houston Methodist Hospital, Houston, Texas
| | - Michael J Reardon
- Houston Methodist DeBakey Heart& Vascular Center, Houston Methodist Hospital, Houston, Texas
| | - Alan B Lumsden
- Houston Methodist DeBakey Heart& Vascular Center, Houston Methodist Hospital, Houston, Texas
| | | | - Mark G Davies
- Houston Methodist DeBakey Heart& Vascular Center, Houston Methodist Hospital, Houston, Texas
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Management of aortic dissection: medical therapy and intervention. Is there a growing role for endovascular techniques? CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2015; 17:386. [PMID: 25895739 DOI: 10.1007/s11936-015-0386-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OPINION STATEMENT Historically, type B aortic dissection was managed as a medical condition with limited surgical intervention unless aortic rupture occurred. Today, however, evidence is building that highlights the importance of strict medical management, timely surveillance, and windows of opportunity for surgical intervention to address both early and late aortic-based morbidities.
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18
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Desai ND, Gottret JP, Szeto WY, McCarthy F, Moeller P, Menon R, Jackson B, Vallabhajosyula P, Wang GJ, Fairman R, Bavaria JE. Impact of timing on major complications after thoracic endovascular aortic repair for acute type B aortic dissection. J Thorac Cardiovasc Surg 2015; 149:S151-6. [DOI: 10.1016/j.jtcvs.2014.10.105] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2014] [Revised: 10/22/2014] [Accepted: 10/26/2014] [Indexed: 10/24/2022]
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Kim TH, Ko YG, Kwon SW, Choi D, Lee DY, Shim WH, Hyon MS. Large False Lumen Area Is a Predictor of Failed False Lumen Volume Reduction After Stent-Graft Repair in Type B Aortic Dissection. J Endovasc Ther 2014; 21:697-706. [DOI: 10.1583/14-4671mr.1] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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20
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Gargiulo M, Bianchini Massoni C, Gallitto E, Freyrie A, Trimarchi S, Faggioli G, Stella A. Lower limb malperfusion in type B aortic dissection: a systematic review. Ann Cardiothorac Surg 2014; 3:351-67. [PMID: 25133098 DOI: 10.3978/j.issn.2225-319x.2014.07.05] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2014] [Accepted: 07/19/2014] [Indexed: 11/14/2022]
Abstract
BACKGROUND Lower limb malperfusion (LLM) syndrome occurs in up to 40% of complicated type B aortic dissections (TBAD) and in up to 71% of TBAD with malperfusion syndrome. This syndrome is associated with higher 30-day mortality. The aim of this systematic review was to provide clinical and procedural data of patients with LLM syndrome secondary to TBAD. METHODS The PubMed database was systematically searched from January 2000 to June 2014 for English-language publications reporting on demographic data of patients with LLM secondary to TBAD. RESULTS A total of 29 papers were included (10 original articles and 19 case reports), reporting on a total of 138 patients (mean age =58±12 years; male =87%). Lower limb complications developed in acute and chronic TBAD in 134 (97%) and 4 (3%) cases, respectively. LLM presented with acute limb ischemia in 120 (87%) patients. Bilateral clinical presentation occurred in 56% (40/72) of cases. LLM was the only clinically detected malperfusion in 52% of cases (44/84). In 40% (35/84) and 25% (21/84) of cases, LLM was clinically associated with renal and visceral malperfusion, respectively. Radiological imaging showed renal, celiac trunk and superior mesenteric artery involvement in 53% (47/88), 31% (27/88) and 34% (30/88) of cases, respectively. Medical, surgical and endovascular treatments were performed in 22 (16%), 51 (37%) and 65 (47%) patients, respectively. Thirty-day morbidity was 31% (13/42) and 46% (6/13) following surgical and endovascular treatment, respectively. Thirty-day mortality was 14% (5/36) and 8% (2/26) following surgical and endovascular treatment, respectively. CONCLUSIONS LLM syndrome secondary to TBAD usually developed during the acute phase and, in most cases, presented with acute limb ischemia. Bilateral clinical presentation occurred in more than half of cases. Renal and visceral malperfusion were frequently associated with lower limb flow reduction but LLM was the only clinically detected malperfusion in more than half of patients. Surgical fenestration was burdened with significant complication rates and 30-day mortality. Endovascular procedures showed lower mortality but complication rates remained high.
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Affiliation(s)
- Mauro Gargiulo
- Vascular Surgery, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Policlinico Sant'Orsola-Malpighi, Bologna, Italy ; 2 Vascular Surgery, Department of Cardiovascular Surgery, Thoracic Aortic Research Center, Policlinico San Donato I.R.C.C.S., University of Milan, Italy
| | - Claudio Bianchini Massoni
- Vascular Surgery, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Policlinico Sant'Orsola-Malpighi, Bologna, Italy ; 2 Vascular Surgery, Department of Cardiovascular Surgery, Thoracic Aortic Research Center, Policlinico San Donato I.R.C.C.S., University of Milan, Italy
| | - Enrico Gallitto
- Vascular Surgery, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Policlinico Sant'Orsola-Malpighi, Bologna, Italy ; 2 Vascular Surgery, Department of Cardiovascular Surgery, Thoracic Aortic Research Center, Policlinico San Donato I.R.C.C.S., University of Milan, Italy
| | - Antonio Freyrie
- Vascular Surgery, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Policlinico Sant'Orsola-Malpighi, Bologna, Italy ; 2 Vascular Surgery, Department of Cardiovascular Surgery, Thoracic Aortic Research Center, Policlinico San Donato I.R.C.C.S., University of Milan, Italy
| | - Santi Trimarchi
- Vascular Surgery, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Policlinico Sant'Orsola-Malpighi, Bologna, Italy ; 2 Vascular Surgery, Department of Cardiovascular Surgery, Thoracic Aortic Research Center, Policlinico San Donato I.R.C.C.S., University of Milan, Italy
| | - Gianluca Faggioli
- Vascular Surgery, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Policlinico Sant'Orsola-Malpighi, Bologna, Italy ; 2 Vascular Surgery, Department of Cardiovascular Surgery, Thoracic Aortic Research Center, Policlinico San Donato I.R.C.C.S., University of Milan, Italy
| | - Andrea Stella
- 1 Vascular Surgery, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Policlinico Sant'Orsola-Malpighi, Bologna, Italy ; 2 Vascular Surgery, Department of Cardiovascular Surgery, Thoracic Aortic Research Center, Policlinico San Donato I.R.C.C.S., University of Milan, Italy
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Wiedemann D, Ehrlich M, Amabile P, Lovato L, Rousseau H, Evangelista-Masip A, Moeller P, Bavaria J. Emergency endovascular stent grafting in acute complicated type B dissection. J Vasc Surg 2014; 60:1204-1208. [PMID: 24998839 DOI: 10.1016/j.jvs.2014.06.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2014] [Accepted: 06/03/2014] [Indexed: 10/25/2022]
Abstract
OBJECTIVE The objective of this study was to assess midterm results of emergency endovascular stent grafting for patients with life-threatening complications of acute type B aortic dissection. METHODS Between March 1999 and November 2011, 110 patients (86 men, 24 women) with complications of acute type B aortic dissection (mean age, 61 years; range, 19-87 years) were treated with thoracic endovascular aortic repair for malperfusion (55.5%) or aortic rupture (53.6%) in five major European referral centers and one U.S. referral center. Additional comorbidities included hypertension in 90 patients (82%), diabetes in 14 patients (13%), and chronic obstructive pulmonary disease in six patients (6%). Eleven patients (10%) had undergone previous aortic surgery. RESULTS Overall hospital mortality was 12% (n = 13), with 14 late deaths after hospital discharge. In-hospital complications occurred in 32 patients (36%); 10 patients developed postoperative renal failure, five patients experienced new permanent neurologic symptoms, and six patients (5.4%) experienced retrograde type A aortic dissection. Furthermore, nine patients (8%) developed an early type I endoleak. Actuarial survival at 1 and 5 years was 85% and 73%, respectively. Postprocedural computed tomography angiography showed complete or partial thrombosis of the false lumen at the stent graft level in 61% and 23% of all patients, respectively. Freedom from treatment failure according to the Stanford classification was 82%, 75%, and 59% at 1, 3, and 5 years. CONCLUSIONS Endovascular repair of complicated acute type B aortic dissection is proven to be a technically feasible and effective treatment modality in this relatively difficult patient cohort. Short-term and midterm results are persuasive; however, the long-term efficacy needs to be further evaluated.
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Affiliation(s)
- Dominik Wiedemann
- Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria.
| | - Marek Ehrlich
- Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
| | - Philippe Amabile
- Department of Vascular Surgery, Hôpital de la Timone, Marseille, France
| | - Luigi Lovato
- Cardiovascular Department, Unit of Cardiovascular Radiology, University Hospital S. Orsola, Bologna, Italy
| | - Hervé Rousseau
- Department of Radiology, University Hospital Rangueil, Toulouse, France
| | | | - Patrick Moeller
- Division of Cardiovascular Surgery, University of Pennsylvania Medical Center, Philadelphia, Pa
| | - Joseph Bavaria
- Division of Cardiovascular Surgery, University of Pennsylvania Medical Center, Philadelphia, Pa
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Chan KK, Rabkin SW. Increasing prevalence of hypertension among patients with thoracic aorta dissection: trends over eight decades--a structured meta-analysis. Am J Hypertens 2014; 27:907-17. [PMID: 24522500 DOI: 10.1093/ajh/hpt293] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND This structured metaanalysis focused on determining the relationship between hypertension (HTN) and thoracic aortic dissection (TAD). METHODS Electronic searches were conducted using the MedLine database, for the period 1946 through May 2013, and manual searches from reference lists. Demographic data, patient diagnosis, and HTN prevalence were extracted from each study. Data were analyzed using weighted averages, metaanalysis, analysis of variance, trend analysis, and multivariate analysis. RESULTS A total of 8,086 cases of TAD from 75 studies over eight decades were assessed. Overall prevalence of HTN in TAD was 66.7% ± 17.5%. An increase of approximately 5.6% in HTN prevalence in TAD cases occurred in every decade. Prevalence of HTN in type A dissections steadily increased, with an overall prevalence of 64.8% ± 21.3%, while in type B dissections, prevalence abruptly increased from 1950 to 1970 and remained constant thereafter, with an overall prevalence of 78.7% ± 8.6%. Trend analysis demonstrated significant (P < 0.001) and linear increasing trends for the prevalence of HTN and age at presentation. Multivariate analysis demonstrated that a history of HTN was significantly (P < 0.001) associated with increasing trends of over time, which was independent of the relationship between age and TAD. CONCLUSIONS The proportion of TAD patients with HTN has been increasing over eight decades. Age at presentation of TAD has also been incrementally increasing, but the increase in HTN was independent of age in multivariate analysis. The trend for increasing HTN prevalence was more evident in type A TAD. These data highlight a need to focus on HTN management in patients with thoracic aortic aneurysm.
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Affiliation(s)
- Kenneth K Chan
- University of British Columbia, Department of Medicine-Cardiology, Vancouver, British Columbia, Canada
| | - Simon W Rabkin
- University of British Columbia, Department of Medicine-Cardiology, Vancouver, British Columbia, Canada.
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Oikonomou K, Katsargyris A, Ritter W, Spinelli D, Seto Y, Verhoeven EL. Endovascular management of chronic post-dissection aneurysms. Ann Cardiothorac Surg 2014; 3:307-13. [PMID: 24967171 DOI: 10.3978/j.issn.2225-319x.2014.04.02] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2013] [Accepted: 03/23/2014] [Indexed: 11/14/2022]
Abstract
Open repair is still the gold standard in acute type A dissection. Endovascular repair is advocated for complicated acute type B dissections. Recent evidence also supports the role of endovascular repair in a larger proportion of uncomplicated acute type B dissections. The role of endovascular repair in chronic post-dissection aneurysms, however, is still unclear. Most commonly, post-dissection aneurysms involve the thoracoabdominal aorta, making the use of fenestrated/branched stent-grafts to achieve complete aneurysm exclusion mandatory. These fenestrated/branched stent-grafts have been used with success in atherosclerotic thoracoabdominal aortic aneurysms (TAAAs). In chronic post-dissection aneurysms, however, additional technical challenges arise. The usually narrow true lumen makes the use of branches more tedious and overall planning difficult. A second technical challenge relates to the fact that visceral branches can also originate from the false lumen. In such cases, perforation of the stiff chronic dissection flap is required to obtain access to the vessel. During the period January 2010 to November 2013, 17 patients (13 males, mean age 65±7.8 years) with chronic thoracoabdominal aneurismal degeneration following acute dissection were treated in our department with the use of fenestrated/branched stent-grafts. Technical success was achieved in all cases (100%). Perioperative mortality was two (11.8%) patients. One patient died due to multiple organ failure and one due to cardiac failure. No case of paraplegia was observed. During a 12-month median follow-up (range, 4-28 months) no aneurysm-related deaths were observed. Reintervention was required in three cases to repair a type Ib endoleak from a side branch. Endovascular treatment with fenestrated/branched stent-grafts is feasible for chronic post-dissection aneurysms. Standard thoracic stent-grafting is an option in a minority of patients, when the aneurysm is limited to the thoracic segment. Fenestrated and branched devices can successfully be used for aneurysms extending to the thoracoabdominal aorta.
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Affiliation(s)
- Kyriakos Oikonomou
- 1 Department of Vascular and Endovascular Surgery, and 2 Interventional Radiology, Paracelsus Medical University, Nuremberg, Germany
| | - Athanasios Katsargyris
- 1 Department of Vascular and Endovascular Surgery, and 2 Interventional Radiology, Paracelsus Medical University, Nuremberg, Germany
| | - Wolfgang Ritter
- 1 Department of Vascular and Endovascular Surgery, and 2 Interventional Radiology, Paracelsus Medical University, Nuremberg, Germany
| | - Domenico Spinelli
- 1 Department of Vascular and Endovascular Surgery, and 2 Interventional Radiology, Paracelsus Medical University, Nuremberg, Germany
| | - Yuki Seto
- 1 Department of Vascular and Endovascular Surgery, and 2 Interventional Radiology, Paracelsus Medical University, Nuremberg, Germany
| | - Eric L Verhoeven
- 1 Department of Vascular and Endovascular Surgery, and 2 Interventional Radiology, Paracelsus Medical University, Nuremberg, Germany
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Alsac JM, Girault A, El Batti S, Abou Rjeili M, Alomran F, Achouh P, Julia P, Fabiani JN. Experience of the Zenith Dissection Endovascular System in the emergency setting of malperfusion in acute type B dissections. J Vasc Surg 2014; 59:645-50. [DOI: 10.1016/j.jvs.2013.09.004] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2013] [Revised: 08/30/2013] [Accepted: 09/03/2013] [Indexed: 11/26/2022]
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Abstract
TEVAR is a new strategy for treating both acute and chronic type B aortic dissection. The JSC guidelines classify TEVAR as a Class I recommendation for cases of complicated acute type B dissection and a Class IIa recommendation for cases of chronic type B aortic dissection. While TEVAR has been primarily applied to treat complicated acute type B aortic dissection in Europe and the USA, the procedure remains an off-label treatment strategy for aortic dissection in Japan. The current state of TEVAR for type B aortic dissection in Japan from 2001 to 2011 is estimated in the annual reports of the Japanese Association for Thoracic Surgery. The number of acute type B aortic dissection patients treated with transluminal stent grafting increased rapidly after 2008, from 10 cases in 2001 to 76 cases in 2010. Meanwhile, the number acute type B aortic dissection patients treated with any type of surgery has increased gradually, from 100 cases in 2001 to 194 cases in 2009. The number of chronic type B aortic dissection patients treated with transluminal stent grafting increased abruptly in 2010, reaching 346 cases, which accounted for one-third of all surgical procedures for chronic type B aortic dissection. Furthermore, the number of open surgeries for chronic type B aortic dissection has also increased gradually, from 401 cases in 2001 to 947 cases in 2011. At present, open surgery, TEVAR and hybrid procedures are available to treat patients with type B aortic dissection. The use of a multidisciplinary team approach is mandatory when selecting the appropriate surgical strategy.
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The Role of Age in Complicated Acute Type B Aortic Dissection. Ann Thorac Surg 2013; 96:2129-34. [DOI: 10.1016/j.athoracsur.2013.06.056] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2013] [Revised: 06/09/2013] [Accepted: 06/14/2013] [Indexed: 11/21/2022]
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Hata M, Akiyama K, Orime Y, Wakui S, Shiono M. Case of sudden death from retrograde type A dissection two days after surgery for a type B dissecting aneurysm. Ann Thorac Cardiovasc Surg 2013; 20 Suppl:915-7. [PMID: 24200665 DOI: 10.5761/atcs.cr.13-00211] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
A 64-year-old man underwent a descending aortic replacement for a chronic type B dissecting aneurysm with left thoracotomy. The patient was weaned from the mechanical ventilator immediately after surgery without any neurological complications. However, on the second post-operative day, he suddenly suffered from cardiopulmonary arrest when talking with his family. Despite 6 hours of cardiopulmonary resuscitation, the patient died. The postmortem examination revealed a 1000 mL blood volume and huge hematoma in the pericardium owing to a retrograde type A dissection, which descended from an intimal laceration between the common carotid and left subclavian arteries that corresponded with aortic cross clamping. We here report a rare case of iatrogenic retrograde type A dissection caused by surgical clamping on the aortic arch 2 days post-surgery.
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Affiliation(s)
- Mitsumasa Hata
- Department of Cardiovascular Surgery, Surugadai Nihon University Hospital, Tokyo, Japan
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Steuer J, Björck M, Mayer D, Wanhainen A, Pfammatter T, Lachat M. Distinction between Acute and Chronic Type B Aortic Dissection: Is there a Sub-acute Phase? Eur J Vasc Endovasc Surg 2013; 45:627-31. [DOI: 10.1016/j.ejvs.2013.03.013] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2012] [Accepted: 03/15/2013] [Indexed: 10/26/2022]
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Sobocinski J, Dias N, Berger L, Midulla M, Hertault A, Sonesson B, Resch T, Haulon S. Endograft Repair of Complicated Acute Type B Aortic Dissections. Eur J Vasc Endovasc Surg 2013; 45:468-74. [DOI: 10.1016/j.ejvs.2013.01.031] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2012] [Accepted: 01/22/2013] [Indexed: 10/27/2022]
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Progress in management of malperfusion syndrome from type B dissections. J Vasc Surg 2013; 57:1283-90; discussion 1290. [PMID: 23375604 DOI: 10.1016/j.jvs.2012.10.101] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2012] [Revised: 10/17/2012] [Accepted: 10/18/2012] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Malperfusion syndrome is a known predictor of poor outcomes in acute type B dissection. We describe our experience with revascularization in the acute setting. METHODS Patients undergoing intervention for ischemia complicated acute type B dissection between November 1999 and March 2011 were reviewed. Details of presenting condition, surgical intervention, and postoperative course were collected. Descriptive and inferential statistical analyses included survival and freedom from reintervention using Cox proportional hazards models. RESULTS A total of 61 patients were identified with malperfusion in at least one territory, including spinal cord 7/61 (12%), mesenteric 37/61 (61%), renal 45/61 (73%), and lower extremity 38/61 (62%). Thoracic stent grafts were placed in all patients, and 41% of patients required adjunctive branch vessel stenting. After intervention, resolution of the ischemia was reported in 57/61 (93%) of patients. The 30-day/in-hospital mortality was 21.3%. The 6-month, 1-year, and 5-year survival was 75% (95% CI, 65%-87%), 71% (95% CI, 61%-84%), and 56% (95% CI, 43%-74%), respectively. The 6-month, 1-year, and 5-year freedom from reintervention was 84% (95% CI, 75%-95%), 76% (95% CI, 65%-90%), and 42% (95% CI, 24%-76%), respectively. Territory of ischemia was not independently associated with mortality, but placement of a stent graft proximal to the subclavian artery was associated with poor outcome hazard ratio 2.91 (95% CI, 1.09-8.11; P = .034). CONCLUSIONS Malperfusion in any territory at the time of presentation in patients with type B dissections can be treated with endovascular intervention with acceptable outcomes. Opposed to branch vessel intervention alone, increased aortic intervention with regard to proximal coverage may signify more serious disease is associated with worse outcome.
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Xiong J, Zhang M, Guo W, Liu X, Yin T, Jia X, Zhang H, Xu Y, Wang L. Early malperfusion, ischemia reperfusion injury, and respiratory failure in acute complicated type B aortic dissection after thoracic endovascular repair. J Cardiothorac Surg 2013; 8:17. [PMID: 23342986 PMCID: PMC3639915 DOI: 10.1186/1749-8090-8-17] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2012] [Accepted: 01/08/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The aim of this study was to determine the early mortality and major complications of acute complicated type B aortic dissection (ACBD) after thoracic endovascular aortic repair (TEVAR). METHODS Twenty-six consecutive patients with ACBD who underwent TEVAR were included. Clinical indications before TEVAR and in-hospital mortality and major complications after TEVAR were analyzed and compared with similar reports. RESULTS TEVAR was technically successful in all cases. In-hospital mortality occurred in four patients (15%), and major complications occurred in an additional four patients (15%). Three of the four (75%) of the deaths were associated with malperfusion and ischemia reperfusion injury (IRI), and 3/4 (75%) of the major complications were caused by respiratory failure (RF). CONCLUSIONS In-hospital mortality associated strongly with severe end-organ malperfusion and IRI, while major complications associated with RF, during TEVAR. Our results indicate that malperfusion, IRI and respiratory failure during TEVAR should be carefully monitored and aggressively treated.
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Affiliation(s)
- Jiang Xiong
- Departments of Vascular Surgery, Clinical Division of Surgery, Chinese PLA General Hospital, Beijing, China
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Qin YL, Deng G, Li TX, Jing RW, Teng GJ. Risk factors of incomplete thrombosis in the false lumen after endovascular treatment of extensive acute type B aortic dissection. J Vasc Surg 2012; 56:1232-8. [DOI: 10.1016/j.jvs.2012.04.019] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2011] [Revised: 03/09/2012] [Accepted: 04/08/2012] [Indexed: 11/25/2022]
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Abstract
The term "acute aortic syndrome" (AAS) refers to a spectrum of life-threatening thoracic aortic pathologies including intramural hematoma, penetrating atherosclerotic ulcer, and aortic dissection. Clinically, patients often present with characteristic aortic pain. AAS often leads to aortic rupture. Therefore, recognition of this condition, its prompt diagnosis, and timely treatment is crucial to obtain clinical success and improved overall survival. The management of AAS, however, remains a therapeutic challenge. Endovascular strategies have gained wide acceptance and now represent a minimally invasive alternative to traditional open surgery. Several studies have shown endovascular repair of varying thoracic aortic pathologies to be technically feasible with fewer complications than open surgery. In this review, the authors discuss AAS pathology and its management, with particular attention to the current role of endovascular aortic repair and its treatment.
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Affiliation(s)
- Parag J Patel
- Division of Vascular and Interventional Radiology, Department of Radiology, Medical College of Wisconsin, Froedtert Memorial Lutheran Hospital, Milwaukee Wisconsin
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Valente T, Rossi G, Lassandro F, Rea G, Marino M, Dialetto G, Muto R, Scaglione M. Unusual complications of endovascular repair of the thoracic aorta: MDCT findings. Radiol Med 2012; 117:831-54. [PMID: 22228128 DOI: 10.1007/s11547-011-0771-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2011] [Accepted: 06/20/2011] [Indexed: 11/26/2022]
Abstract
With the development of minimally invasive surgical techniques, endovascular stent-graft placement has become an accepted and widely used alternative to the traditional surgical repair of aortic disease and is gaining acceptance as the treatment of choice. Many studies show that endovascular stent-graft therapy is safe and effective, although complications related to this treatment are also recognised. Although the incidence of major complication is low, neurological sequelae remain the major concern of endovascular repair. With growing experience, however, the spectrum of mid- and long-term complications has broadened to include potentially disastrous events, other than paraplegia or stroke, that require diligent surveillance. Three-dimensional data sets acquired quickly by multidetector computed tomography (MDCT) allow multiplanar reformations and 3D viewing, as well as quantitative assessment of vessel lumens, walls and surroundings. Although a large portion of radiologists will not be involved in the actual endograft deployment, many will be involved in the interpretation of postprocedural surveillance studies. Accordingly, the goal of this report is to summarise our experience with the presentation, diagnostic approach, management and outcomes of these unusual, but potentially catastrophic, postendovascular aortic repair complications to highlight their significance and increase familiarity with them among the imaging community. Increasing awareness of these complications may facilitate rapid diagnosis and/or triage and treatment.
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Affiliation(s)
- T Valente
- Dipartimento di Diagnostica per Immagini, Servizio di Radiologia, A.O.R.N. Monaldi, 80131, Napoli, Italy
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Jazaeri O, Gupta R, Rochon PJ, Reece TB. Endovascular approaches and perioperative considerations in acute aortic dissection. Semin Cardiothorac Vasc Anesth 2011; 15:141-62. [PMID: 22194281 DOI: 10.1177/1089253211425424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Aortic dissections remain complicated management issues both in the acute setting and in the chronic setting. Acute problems revolve around malperfusion syndromes or rupture, whereas chronic issues progress from the development of aneurysms in the residual dissected aorta. Endovascular approaches to dealing with these difficult situations are being used more frequently to treat acute issues in type B dissections and prevent secondary complications in type A dissections that may require significant intervention in the future. This article discusses the endovascular approaches employed in the care of acute dissections with particular attention toward the anesthetic considerations involved in these challenging cases.
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Affiliation(s)
- Omid Jazaeri
- University of Colorado Denver, Aurora, CO 80045, USA
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36
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Nienaber CA, Kische S, Ince H, Fattori R. Thoracic endovascular aneurysm repair for complicated type B aortic dissection. J Vasc Surg 2011; 54:1529-33. [DOI: 10.1016/j.jvs.2011.06.099] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2011] [Revised: 06/16/2011] [Accepted: 06/25/2011] [Indexed: 11/24/2022]
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Descending aortic diameter of 5.5 cm or greater is not an accurate predictor of acute type B aortic dissection. J Thorac Cardiovasc Surg 2011; 142:e101-7. [DOI: 10.1016/j.jtcvs.2010.12.032] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2010] [Revised: 11/23/2010] [Accepted: 12/17/2010] [Indexed: 11/18/2022]
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Naughton PA, Garcia-Toca M, Matsumura JS, Rodriguez HE, Morasch MD, Resnick SA, Eskandari MK. Complicated acute type B thoracic aortic dissections: endovascular treatment for visceral malperfusion and pseudoaneurysms. Vasc Endovascular Surg 2011; 45:219-26. [PMID: 21478244 DOI: 10.1177/1538574410395039] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE Morbidity and mortality of acute type B thoracic aortic dissections remain alarmingly high. Endoluminal options are promising. METHODS A single-center 5-year review of 17 acute type B aortic dissections complicated by visceral malperfusion (11) or pseudoaneurysm formation (6) treated with endovascular intervention. Interventional techniques included endografting (15) and/or percutaneous fenestration (4). Median follow-up is 28 months (range 0-76 months). RESULTS Median age was 55 years; 30-day death, stroke, and paraplegia rates were 0%, 17.6%, and 5.9%. Success reversing visceral ischemia or sealing a pseudoaneurysm was 100%. Cross-sectional imaging demonstrated that the false lumen was thrombosed in 9 patients, partially thrombosed in 6 patients. Late events include 1 delayed proximal type I endoleak, 1 delayed rupture of the thoracic aorta requiring successful emergent open surgical repair, and 2 unrelated late deaths. CONCLUSION Endovascular approaches to type B dissections presenting with visceral malperfusion and/or pseudoaneurysm can achieve acceptable early results.
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Affiliation(s)
- Peter A Naughton
- Division of Vascular Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA
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Kim KM, Donayre CE, Reynolds TS, Kopchok GE, Walot I, Chauvapun JP, White RA. Aortic remodeling, volumetric analysis, and clinical outcomes of endoluminal exclusion of acute complicated type B thoracic aortic dissections. J Vasc Surg 2011; 54:316-24; discussion 324-5. [DOI: 10.1016/j.jvs.2010.11.134] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2010] [Revised: 11/08/2010] [Accepted: 11/28/2010] [Indexed: 11/29/2022]
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San Norberto EM, Gutiérrez VM, Taylor J, Vaquero C. Coil embolization of persistent false lumen after stent graft repair of type B aortic dissection. J Vasc Surg 2011; 54:201-4. [DOI: 10.1016/j.jvs.2010.11.110] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2010] [Revised: 11/17/2010] [Accepted: 11/17/2010] [Indexed: 10/18/2022]
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Discriminant Analysis of Native Thoracic Aortic Curvature: Risk Prediction for Endoleak Formation After Thoracic Endovascular Aortic Repair. J Vasc Interv Radiol 2011; 22:974-979.e2. [DOI: 10.1016/j.jvir.2011.02.031] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2010] [Revised: 02/16/2011] [Accepted: 02/22/2011] [Indexed: 11/30/2022] Open
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Nienaber CA, Ince H. Stent-grafts for aortic dissection: what is really needed? J Endovasc Ther 2011; 18:144-5. [PMID: 21521052 DOI: 10.1583/10-3233c.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Development of in vivo quantitative geometric mapping of the aortic arch for advanced endovascular aortic repair: feasibility and preliminary results. J Vasc Interv Radiol 2011; 22:980-6. [PMID: 21459612 DOI: 10.1016/j.jvir.2011.01.434] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2010] [Revised: 12/19/2010] [Accepted: 01/11/2011] [Indexed: 11/23/2022] Open
Abstract
PURPOSE To evaluate whether quantitative characterization of aortic arch geometry including its branches is feasible based on in vivo computed tomography (CT) angiography and magnetic resonance (MR) angiography data in healthy and diseased aortic arches. MATERIALS AND METHODS Ten healthy volunteers, 10 patients with abdominal aortic disease, and 10 patients with aortic arch disease underwent MR angiography (10 volunteers) or CT angiography (20 patients). Commercial software was used for individual segmentation of supraaortic arteries. In-house software was developed for segmentation of aortic arch landmarks based on standardized multiplanar reformations (MPRs) and for subsequent aortic arch mapping. RESULTS Supraaortic arteries and aortic arch landmarks were successfully segmented in all 30 subjects for CT angiography and MR angiography data. Significant tapering within the first centimeter was observed in all supraaortic arteries (P < .001). The three supraaortic arteries showed significantly different vessel diameters and areas (P < .001). The software developed in-house allowed detailed aortic arch mapping with quantitative definitions of the positional relationships between each supraaortic artery and the aorta. Distances between supraaortic arteries were less than 5 mm in 77.6% (mean 4.1 mm ± 3.8). The brachiocephalic trunk tended to be positioned on the right side of the aortic arch, and the left subclavian and left common carotid arteries tended to be positioned on the left side of the aortic arch. CONCLUSIONS The feasibility and application of a postprocessing method allowing quantification of geometry of supraaortic arteries and aortic arch mapping were successfully demonstrated. Validation and evaluation of clinical implications are warranted.
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White RA, Miller DC, Criado FJ, Dake MD, Diethrich EB, Greenberg RK, Piccolo RS, Siami FS. Report on the results of thoracic endovascular aortic repair for acute, complicated, type B aortic dissection at 30 days and 1 year from a multidisciplinary subcommittee of the Society for Vascular Surgery Outcomes Committee. J Vasc Surg 2011; 53:1082-90. [DOI: 10.1016/j.jvs.2010.11.124] [Citation(s) in RCA: 98] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2010] [Revised: 11/29/2010] [Accepted: 11/29/2010] [Indexed: 10/18/2022]
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Ham SW, Rowe VL, Ochoa C, Chong T, Lee WM, Baker CJ, Cohen RG, Cunningham MJ, Weaver FA, Woo K. Thoracic Aortic Stent-Grafting for Acute, Complicated, Type B Aortic Dissections. Ann Vasc Surg 2011; 25:333-9. [PMID: 21276707 DOI: 10.1016/j.avsg.2010.09.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2010] [Revised: 09/16/2010] [Accepted: 09/20/2010] [Indexed: 11/29/2022]
Affiliation(s)
- Sung Wan Ham
- Aortic Center, Cardio-Vascular Thoracic Institute, The University of Southern California, Department of Surgery, 1520 S. San Pablo St., Los Angeles, CA 90033, USA
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Steuer J, Eriksson MO, Nyman R, Björck M, Wanhainen A. Early and Long-term Outcome after Thoracic Endovascular Aortic Repair (TEVAR) for Acute Complicated Type B Aortic Dissection. Eur J Vasc Endovasc Surg 2011; 41:318-23. [DOI: 10.1016/j.ejvs.2010.11.024] [Citation(s) in RCA: 83] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2010] [Accepted: 11/25/2010] [Indexed: 10/18/2022]
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49
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Endovascular management for ruptured Stanford B acute aortic dissection. Gen Thorac Cardiovasc Surg 2011; 59:123-8. [DOI: 10.1007/s11748-010-0644-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2010] [Accepted: 05/16/2010] [Indexed: 10/18/2022]
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50
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Field ML, Kuduvalli M, Oo A. Multidisciplinary team-led management of acute Type B aortic dissection in the United Kingdom? J R Soc Med 2011; 104:53-8. [PMID: 21282794 PMCID: PMC3031650 DOI: 10.1258/jrsm.2010.100294] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Mark L Field
- The Thoracic Aortic Aneurysm Service, The Liverpool Heart and Chest Hospital, Liverpool L14 3PE, UK.
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