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Sulzer TAL, Vacirca A, Mesnard T, Baghbani-Oskouei A, Savadi S, Kanamori LR, van Lier F, de Bruin JL, Verhagen HJM, Oderich GS. How We Would Treat Our Own Thoracoabdominal Aortic Aneurysm. J Cardiothorac Vasc Anesth 2024; 38:379-387. [PMID: 38042741 DOI: 10.1053/j.jvca.2023.10.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 10/15/2023] [Accepted: 10/24/2023] [Indexed: 12/04/2023]
Abstract
This manuscript is intended to provide a comprehensive review of the current state of knowledge on endovascular repair of thoracoabdominal aortic aneurysms (TAAAs). The management of these complex aneurysms requires an interdisciplinary and patient-specific approach in high-volume centers. An index case is used to discuss the diagnosis and treatment of a patient undergoing fenestrated-branched endovascular aneurysm repair for a TAAA.
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Affiliation(s)
- Titia A L Sulzer
- Department of Cardiothoracic & Vascular Surgery, Advanced Aortic Research Program at the University of Texas Health Science Center at Houston, McGovern Medical School, Houston, TX; Department of Vascular Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Andrea Vacirca
- Department of Cardiothoracic & Vascular Surgery, Advanced Aortic Research Program at the University of Texas Health Science Center at Houston, McGovern Medical School, Houston, TX
| | - Thomas Mesnard
- Department of Cardiothoracic & Vascular Surgery, Advanced Aortic Research Program at the University of Texas Health Science Center at Houston, McGovern Medical School, Houston, TX
| | - Aidin Baghbani-Oskouei
- Department of Cardiothoracic & Vascular Surgery, Advanced Aortic Research Program at the University of Texas Health Science Center at Houston, McGovern Medical School, Houston, TX
| | - Safa Savadi
- Department of Cardiothoracic & Vascular Surgery, Advanced Aortic Research Program at the University of Texas Health Science Center at Houston, McGovern Medical School, Houston, TX
| | - Lucas Ruiter Kanamori
- Department of Cardiothoracic & Vascular Surgery, Advanced Aortic Research Program at the University of Texas Health Science Center at Houston, McGovern Medical School, Houston, TX
| | - Felix van Lier
- Department of Anesthesiology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Jorg L de Bruin
- Department of Vascular Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Hence J M Verhagen
- Department of Vascular Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Gustavo S Oderich
- Department of Cardiothoracic & Vascular Surgery, Advanced Aortic Research Program at the University of Texas Health Science Center at Houston, McGovern Medical School, Houston, TX.
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Isselbacher EM, Preventza O, Hamilton Black J, Augoustides JG, Beck AW, Bolen MA, Braverman AC, Bray BE, Brown-Zimmerman MM, Chen EP, Collins TJ, DeAnda A, Fanola CL, Girardi LN, Hicks CW, Hui DS, Schuyler Jones W, Kalahasti V, Kim KM, Milewicz DM, Oderich GS, Ogbechie L, Promes SB, Ross EG, Schermerhorn ML, Singleton Times S, Tseng EE, Wang GJ, Woo YJ, Faxon DP, Upchurch GR, Aday AW, Azizzadeh A, Boisen M, Hawkins B, Kramer CM, Luc JGY, MacGillivray TE, Malaisrie SC, Osteen K, Patel HJ, Patel PJ, Popescu WM, Rodriguez E, Sorber R, Tsao PS, Santos Volgman A, Beckman JA, Otto CM, O'Gara PT, Armbruster A, Birtcher KK, de Las Fuentes L, Deswal A, Dixon DL, Gorenek B, Haynes N, Hernandez AF, Joglar JA, Jones WS, Mark D, Mukherjee D, Palaniappan L, Piano MR, Rab T, Spatz ES, Tamis-Holland JE, Woo YJ. 2022 ACC/AHA guideline for the diagnosis and management of aortic disease: A report of the American Heart Association/American College of Cardiology Joint Committee on Clinical Practice Guidelines. J Thorac Cardiovasc Surg 2023; 166:e182-e331. [PMID: 37389507 PMCID: PMC10784847 DOI: 10.1016/j.jtcvs.2023.04.023] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/01/2023]
Abstract
AIM The "2022 ACC/AHA Guideline for the Diagnosis and Management of Aortic Disease" provides recommendations to guide clinicians in the diagnosis, genetic evaluation and family screening, medical therapy, endovascular and surgical treatment, and long-term surveillance of patients with aortic disease across its multiple clinical presentation subsets (ie, asymptomatic, stable symptomatic, and acute aortic syndromes). METHODS A comprehensive literature search was conducted from January 2021 to April 2021, encompassing studies, reviews, and other evidence conducted on human subjects that were published in English from PubMed, EMBASE, the Cochrane Library, CINHL Complete, and other selected databases relevant to this guideline. Additional relevant studies, published through June 2022 during the guideline writing process, were also considered by the writing committee, where appropriate. STRUCTURE Recommendations from previously published AHA/ACC guidelines on thoracic aortic disease, peripheral artery disease, and bicuspid aortic valve disease have been updated with new evidence to guide clinicians. In addition, new recommendations addressing comprehensive care for patients with aortic disease have been developed. There is added emphasis on the role of shared decision making, especially in the management of patients with aortic disease both before and during pregnancy. The is also an increased emphasis on the importance of institutional interventional volume and multidisciplinary aortic team expertise in the care of patients with aortic disease.
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Zhang J, Zhang A, Wang Z, Sun Y, Li X, Jin Q, Shi J, Hou J, Zhang L, Yang B. A Comparative Study of Clinical and Aortic Morphological Characteristics between Bovine Aortic Arch and Normal Aortic Arch in Patients with Acute Type B Aortic Dissection. Cardiology 2023; 148:409-417. [PMID: 37385225 DOI: 10.1159/000531731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 06/19/2023] [Indexed: 07/01/2023]
Abstract
INTRODUCTION The purpose of this study was to analyze the difference in clinical and aortic morphological features between the bovine aortic arch and normal aortic arch in patients with acute type B aortic dissection (aTBAD). METHODS A total of 133 patients diagnosed with aTBAD were retrospectively collected. Based on aortic arch morphology, they were divided into the bovine aortic arch group (n = 20) and the normal aortic arch group (n = 113). Aortic morphological features were assessed on computed tomographic angiography. Clinical and aortic morphological features were then compared between the bovine aortic arch and normal aortic arch groups. RESULTS Patients in the bovine aortic arch group were significantly younger and with higher weight and BMI than the normal aortic arch group (p < 0.001, p = 0.045, and p = 0.016, respectively). The total aortic length in the bovine aortic arch group was significantly shorter than that in the normal aortic arch group (p = 0.039). The tortuosity of descending thoracic aorta, the tortuosity of descending aorta, and the angulation of aortic arch were significantly lower in the bovine aortic arch group (p = 0.004, p = 0.015, and p = 0.023, respectively). The width of descending aorta, the height of aorta arch, and the angle of ascending aorta were significantly smaller in the bovine aortic arch group (p = 0.045, p = 0.044, and p = 0.042, respectively). CONCLUSION When the aTBAD occurred, patients with bovine aortic arch were prone to be younger and with higher BMI than those with normal aortic arch. The aortic curvature and the total aortic length were lower in patients with bovine aortic arch.
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Affiliation(s)
- Jianhua Zhang
- Department of Radiology, General Hospital of Northern Theater Command, Shenyang, China
- Postgraduate College, China Medical University, Shenyang, China
| | - Anxiaonan Zhang
- Department of Radiology, General Hospital of Northern Theater Command, Shenyang, China
- Postgraduate College, China Medical University, Shenyang, China
| | - Zhenguo Wang
- Department of Radiology, General Hospital of Northern Theater Command, Shenyang, China
- Postgraduate College, China Medical University, Shenyang, China
| | - Yu Sun
- Department of Radiology, General Hospital of Northern Theater Command, Shenyang, China
- Key Laboratory of Cardiovascular Imaging and Research, Liaoning Province, Shenyang, China
| | - Xiaogang Li
- Department of Radiology, General Hospital of Northern Theater Command, Shenyang, China
- Key Laboratory of Cardiovascular Imaging and Research, Liaoning Province, Shenyang, China
| | - Qiuyue Jin
- Department of Radiology, General Hospital of Northern Theater Command, Shenyang, China
- Postgraduate College, Jinzhou Medical University, Jinzhou, China
| | - Jinglong Shi
- Department of Radiology, General Hospital of Northern Theater Command, Shenyang, China
- Postgraduate College, Jinzhou Medical University, Jinzhou, China
| | - Jie Hou
- Department of Radiology, General Hospital of Northern Theater Command, Shenyang, China
- Key Laboratory of Cardiovascular Imaging and Research, Liaoning Province, Shenyang, China
| | - Libo Zhang
- Department of Radiology, General Hospital of Northern Theater Command, Shenyang, China
- Key Laboratory of Cardiovascular Imaging and Research, Liaoning Province, Shenyang, China
| | - Benqiang Yang
- Department of Radiology, General Hospital of Northern Theater Command, Shenyang, China
- Key Laboratory of Cardiovascular Imaging and Research, Liaoning Province, Shenyang, China
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Sun J, Zhang S, Qi H, Sun C, Hou Z, Wang X, Qian X. Association of the bovine aortic arch and bicuspid aortic valve with thoracic aortic disease. BMC Cardiovasc Disord 2023; 23:60. [PMID: 36732689 PMCID: PMC9893652 DOI: 10.1186/s12872-023-03095-0] [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: 10/27/2022] [Accepted: 01/25/2023] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Both bicuspid aortic valve (BAV) and bovine aortic arch (BA) are considered as markers of thoracic aortic disease (TAD). But the association between them is not yet clear. This study aimed to explore the potential association of BAV and BA with TAD. METHODS The study involved 449 participants who underwent their first aortic valve replacement in Fuwai Hospital from June 2017 to March 2018. All patients underwent multidetector computed tomography and echocardiography before surgery. The clinical characteristics were recorded to analyze the association between BAV, BA, and TAD. The univariate and multivariate logistic regression analyses were applied to identify the risk factors for TAD. RESULTS BA accounted for 79.8% of the arch variants and was the most common aortic arch branching variant. BAV was present in 52.6% of the patients with BA and 38.1% of the patients with normal arch (NA). Among the 185 patients in the BAV subgroup, 50 had BA and 135 had NA. No significant differences were found in BAV anatomical phenotype, aortopathy phenotype, and valve function between BA and NA. The multivariate analysis showed that the presence of BAV and male sex were the risk predictors of TAD. BA was not a risk factor for TAD in either univariate or multivariate analysis. CONCLUSIONS The proportion of BAV in patients with BA was significantly higher than that of NA, but the BAV phenotype and aortopathy were not related to BA. BAV was a risk factor for TAD, whereas BA was not associated with TAD.
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Affiliation(s)
- Jing Sun
- grid.506261.60000 0001 0706 7839Department of Cardiovascular Surgery, National Center for Cardiovascular Diseases and Fuwai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, No. 167, North Lishi Street, Xicheng District, Beijing, China ,Department of Cardiovascular Surgery, Yunnan Fuwai Cardiovascular Hospital, Kunming, China
| | - Shuai Zhang
- grid.506261.60000 0001 0706 7839Department of Cardiovascular Surgery, National Center for Cardiovascular Diseases and Fuwai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, No. 167, North Lishi Street, Xicheng District, Beijing, China
| | - Hongxia Qi
- grid.506261.60000 0001 0706 7839Department of Medical Imaging, Ultrasound Division, National Center for Cardiovascular Diseases and Fuwai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Cheng Sun
- grid.506261.60000 0001 0706 7839Department of Cardiovascular Surgery, National Center for Cardiovascular Diseases and Fuwai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, No. 167, North Lishi Street, Xicheng District, Beijing, China
| | - Zhihui Hou
- grid.506261.60000 0001 0706 7839Department of Radiologic Imaging, National Center for Cardiovascular Diseases and Fuwai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Xiaoqi Wang
- Department of Cardiovascular Surgery, Yunnan Fuwai Cardiovascular Hospital, Kunming, China
| | - Xiangyang Qian
- Department of Cardiovascular Surgery, National Center for Cardiovascular Diseases and Fuwai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, No. 167, North Lishi Street, Xicheng District, Beijing, China.
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5
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Isselbacher EM, Preventza O, Hamilton Black J, Augoustides JG, Beck AW, Bolen MA, Braverman AC, Bray BE, Brown-Zimmerman MM, Chen EP, Collins TJ, DeAnda A, Fanola CL, Girardi LN, Hicks CW, Hui DS, Schuyler Jones W, Kalahasti V, Kim KM, Milewicz DM, Oderich GS, Ogbechie L, Promes SB, Gyang Ross E, Schermerhorn ML, Singleton Times S, Tseng EE, Wang GJ, Woo YJ. 2022 ACC/AHA Guideline for the Diagnosis and Management of Aortic Disease: A Report of the American Heart Association/American College of Cardiology Joint Committee on Clinical Practice Guidelines. Circulation 2022; 146:e334-e482. [PMID: 36322642 PMCID: PMC9876736 DOI: 10.1161/cir.0000000000001106] [Citation(s) in RCA: 376] [Impact Index Per Article: 188.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AIM The "2022 ACC/AHA Guideline for the Diagnosis and Management of Aortic Disease" provides recommendations to guide clinicians in the diagnosis, genetic evaluation and family screening, medical therapy, endovascular and surgical treatment, and long-term surveillance of patients with aortic disease across its multiple clinical presentation subsets (ie, asymptomatic, stable symptomatic, and acute aortic syndromes). METHODS A comprehensive literature search was conducted from January 2021 to April 2021, encompassing studies, reviews, and other evidence conducted on human subjects that were published in English from PubMed, EMBASE, the Cochrane Library, CINHL Complete, and other selected databases relevant to this guideline. Additional relevant studies, published through June 2022 during the guideline writing process, were also considered by the writing committee, where appropriate. Structure: Recommendations from previously published AHA/ACC guidelines on thoracic aortic disease, peripheral artery disease, and bicuspid aortic valve disease have been updated with new evidence to guide clinicians. In addition, new recommendations addressing comprehensive care for patients with aortic disease have been developed. There is added emphasis on the role of shared decision making, especially in the management of patients with aortic disease both before and during pregnancy. The is also an increased emphasis on the importance of institutional interventional volume and multidisciplinary aortic team expertise in the care of patients with aortic disease.
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Affiliation(s)
| | | | | | | | | | | | | | - Bruce E Bray
- AHA/ACC Joint Committee on Clinical Data Standards liaison
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Y Joseph Woo
- AHA/ACC Joint Committee on Clinical Practice Guidelines liaison
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6
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Isselbacher EM, Preventza O, Hamilton Black Iii J, Augoustides JG, Beck AW, Bolen MA, Braverman AC, Bray BE, Brown-Zimmerman MM, Chen EP, Collins TJ, DeAnda A, Fanola CL, Girardi LN, Hicks CW, Hui DS, Jones WS, Kalahasti V, Kim KM, Milewicz DM, Oderich GS, Ogbechie L, Promes SB, Ross EG, Schermerhorn ML, Times SS, Tseng EE, Wang GJ, Woo YJ. 2022 ACC/AHA Guideline for the Diagnosis and Management of Aortic Disease: A Report of the American Heart Association/American College of Cardiology Joint Committee on Clinical Practice Guidelines. J Am Coll Cardiol 2022; 80:e223-e393. [PMID: 36334952 PMCID: PMC9860464 DOI: 10.1016/j.jacc.2022.08.004] [Citation(s) in RCA: 129] [Impact Index Per Article: 64.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AIM The "2022 ACC/AHA Guideline for the Diagnosis and Management of Aortic Disease" provides recommendations to guide clinicians in the diagnosis, genetic evaluation and family screening, medical therapy, endovascular and surgical treatment, and long-term surveillance of patients with aortic disease across its multiple clinical presentation subsets (ie, asymptomatic, stable symptomatic, and acute aortic syndromes). METHODS A comprehensive literature search was conducted from January 2021 to April 2021, encompassing studies, reviews, and other evidence conducted on human subjects that were published in English from PubMed, EMBASE, the Cochrane Library, CINHL Complete, and other selected databases relevant to this guideline. Additional relevant studies, published through June 2022 during the guideline writing process, were also considered by the writing committee, where appropriate. STRUCTURE Recommendations from previously published AHA/ACC guidelines on thoracic aortic disease, peripheral artery disease, and bicuspid aortic valve disease have been updated with new evidence to guide clinicians. In addition, new recommendations addressing comprehensive care for patients with aortic disease have been developed. There is added emphasis on the role of shared decision making, especially in the management of patients with aortic disease both before and during pregnancy. The is also an increased emphasis on the importance of institutional interventional volume and multidisciplinary aortic team expertise in the care of patients with aortic disease.
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7
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Saleh QW, Diederichsen ACP, Lindholt JS. Individualized prediction of risk of ascending aortic syndromes. PLoS One 2022; 17:e0270585. [PMID: 35759492 PMCID: PMC9236241 DOI: 10.1371/journal.pone.0270585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Accepted: 06/13/2022] [Indexed: 12/03/2022] Open
Abstract
Objectives Although ascending aortic diameter changes acutely after dissection, recommendation for prophylactic surgery of thoracic aortic aneurysms rely on data from dissected aortas. In this case-control study we aim to identify risk markers for acute and chronic aortic syndromes of the ascending aorta (ACAS-AA). Furthermore, to develop a predictive model for ACAS-AA. Methods We collected data of 188 cases of ACAS-AA and 376 controls standardized to age- and sex of the background population. Medical history and CT-derived aortic morphology were collected. For the dependent outcome ACAS-AA, potential independent risk factors were identified by univariate logistic regression and confirmed in multivariate logistic regression. As post-dissection tubular ascending aortic diameter is prone to expand, this factor was not included in the first model. The individual calculated adjusted odds ratios were then used in ROC-curve analysis to evaluate the diagnostic accuracy of the model. To test the influence of post-ACAS-AA tubular ascending aortic diameter, this was added to the model. Results The following risk factors were identified as independent risk factors for ACAS-AA in multivariate analysis: bicuspid aortic valve (OR 20.41, p = 0.03), renal insufficiency (OR 2.9, p<0.01), infrarenal abdominal aortic diameter (OR 1.08, p<0.01), left common carotid artery diameter (OR 1.40, p<0.01) and aortic width (OR 1.07, p<0.01). Area under the curve was 0.88 (p<0.01). Adding post-ACAS-AA tubular ascending aortic diameter to the model, negated the association of bicuspid aortic valve, renal insufficiency, and left common carotid artery diameter. Area under the curve changed to 0.98 (p<0.01). Conclusions A high performing predictive model for ACAS-AA, free of ascending aortic diameter, can be achieved. Furthermore, we have identified abdominal aortic ectasia as an independent risk factor of ACAS-AA. Integration of potential biomarkers and morphologic variables, derived from undissected aortas, would probably improve the model.
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Affiliation(s)
- Qais Waleed Saleh
- Department of Thoracic-, Cardiac- and Vascular Surgery, Odense University Hospital, Odense, Denmark
- Centre for Individualized Medicine in Arterial Diseases (CIMA), Odense, Denmark
- Centre of Clinical Excellence in Southern Denmark (CAVAC), Odense, Denmark
- * E-mail:
| | - Axel Cosmus Pyndt Diederichsen
- Centre for Individualized Medicine in Arterial Diseases (CIMA), Odense, Denmark
- Centre of Clinical Excellence in Southern Denmark (CAVAC), Odense, Denmark
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | - Jes Sanddal Lindholt
- Department of Thoracic-, Cardiac- and Vascular Surgery, Odense University Hospital, Odense, Denmark
- Centre for Individualized Medicine in Arterial Diseases (CIMA), Odense, Denmark
- Centre of Clinical Excellence in Southern Denmark (CAVAC), Odense, Denmark
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Endovascular treatment of intracranial aneurysms and thoracic aortic aneurysms at One-Stage in a hybrid operating room: A case report. INTERDISCIPLINARY NEUROSURGERY 2022. [DOI: 10.1016/j.inat.2022.101499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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9
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Shang M, Vinholo TF, Buntin J, Zafar MA, Ziganshin BA, Elefteriades JA. Bovine Aortic Arch: A Result of Chance or Mandate of Inheritance? Am J Cardiol 2022; 172:115-120. [PMID: 35321803 PMCID: PMC9978865 DOI: 10.1016/j.amjcard.2022.02.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 02/08/2022] [Accepted: 02/15/2022] [Indexed: 11/20/2022]
Abstract
Previous studies have shown that bovine arch incidence is higher in patients with thoracic aortic aneurysms than in patients without an aneurysm. Although thoracic aortic aneurysm disease is known to be familial in some cases, it remains unknown if bovine arch results from a genetic mutation, thus allowing it to be inherited. Our objective was to determine the heritability of bovine arch from phenotypic pedigrees. We identified 24 probands from an institutional database of 202 living patients with bovine arch who had previously been diagnosed with thoracic aortic aneurysm and who had family members with previous chest computed tomography or magnetic resonance imaging scans. Aortic arch configuration of all first-degree and second-degree relatives was determined from available scans. Heritability of bovine arch was estimated using maximum-likelihood-based variance decomposition methodology implemented by way of the SOLAR package (University of Maryland, Catonsville, Maryland). 43 relatives of 24 probands with bovine arch had preexisting imaging available for review. The prevalence of bovine arch in relatives with chest imaging was 53% (n = 23) and did not differ significantly by gender (male: 64.3%, female: 55.6%, p = 1). The bovine arch was shown to be highly heritable with a heritability estimate (h2) of 0.71 (p = 0.048). In conclusion, the high heritability of bovine arch in our sample population suggests a genetic basis.
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Affiliation(s)
- Michael Shang
- Aortic Institute at Yale-New Haven Hospital, Yale University School of Medicine, New Haven, Connecticut
| | - Thais Faggion Vinholo
- Aortic Institute at Yale-New Haven Hospital, Yale University School of Medicine, New Haven, Connecticut; Division of Cardiac Surgery, Brigham and Women's Hospital, Boston, Massachusetts
| | - Joelle Buntin
- Aortic Institute at Yale-New Haven Hospital, Yale University School of Medicine, New Haven, Connecticut
| | - Mohammad A Zafar
- Aortic Institute at Yale-New Haven Hospital, Yale University School of Medicine, New Haven, Connecticut
| | - Bulat A Ziganshin
- Aortic Institute at Yale-New Haven Hospital, Yale University School of Medicine, New Haven, Connecticut; Department of Cardiovascular and Endovascular Surgery, Kazan State Medical University, Kazan, Russian Federation
| | - John A Elefteriades
- Aortic Institute at Yale-New Haven Hospital, Yale University School of Medicine, New Haven, Connecticut.
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Shaban M, Budhathoki P, Lee S, Bhatt T, Rodriguez Guerra MA, Zaw M. Bovine Aortic Arch, A High-Risk Variant. Cureus 2022; 14:e25456. [PMID: 35774710 PMCID: PMC9239556 DOI: 10.7759/cureus.25456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/28/2022] [Indexed: 11/06/2022] Open
Abstract
The bovine aortic arch is a vascular variant related to an increased incidence of vascular and neurological complications. It should be ruled out in patients with vague neurological symptoms without a clear etiology. Our case is of a 72-year-old female patient who presented with a syncopal episode; the workup incidentally showed the aortic arch bovine variant with evidence of ischemic white matter disease more than expected for age. After reviewing the related literature, we suggest that this aortic variant is likely an independent risk factor for multiple vascular complications. A close follow-up is essential, and screening should be considered for symptomatic family members.
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11
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Evaluation of aortic arch morphologies by computed tomographic angiography in Turkish population. TURKISH JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2022; 30:167-175. [PMID: 36168567 PMCID: PMC9473601 DOI: 10.5606/tgkdc.dergisi.2022.22474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Accepted: 01/23/2022] [Indexed: 11/21/2022]
Abstract
Background: The aim of this study was to evaluate the aortic arch morphologies in the Turkish population using the computed tomography angiography technique.
Methods: Between August 2009 and August 2019, a total of 2,037 (1,003 males, 1,034 females; mean age: 52.8±20.3 years; range, 3 months to 100 years) thoracic computed tomography angiography scans were retrospectively analyzed. The findings were classified as described previously in the literature. The prevalence of aortic arch morphologies and possible relationship with sex were analyzed. The prevalence of variations reported in previous studies was compared with the current study.
Results: The normal aortic arch pattern (type A), observed in 1,562 cases (76.7%), was determined statistically significantly more in males than females (p<0.05). The most common variation, bovine aortic arch (type B1) which observed in a total of 315 cases (15.5%), was determined statistically significantly more in females than males (p<0.05). The second most frequent variation, in which the left vertebral artery originates directly from the aortic arch (type C1) was detected in 97 cases (4.7%). There was also observed to be aberrant right subclavian artery in 21 cases (1%), right-sided aortic arch variation in seven cases (0.4%), and double aortic arch anomaly in four cases (0.1%). In terms of the reported frequency of type B variation, a significant difference was determined between the current and previous studies in Türkiye (p<0.05).
Conclusion: With the largest sample size to date, this study provides comparative information about the prevalence of aortic arch patterns in the Turkish population.
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12
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Pleș L, Cîrstoveanu C, Sima RM, Gorecki GP, Chicea R, Haj Hamoud B. Prenatal Diagnosis of Bovine Aortic Arch Anatomic Variant. Diagnostics (Basel) 2022; 12:diagnostics12030624. [PMID: 35328177 PMCID: PMC8947431 DOI: 10.3390/diagnostics12030624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 02/27/2022] [Accepted: 03/01/2022] [Indexed: 11/16/2022] Open
Abstract
Fetal aortic arch development is an early and complex process that depends on many genetic and environmental factors. The final aortic arch varies greatly; it may take the form of a normal arch, anatomic variant (AAAV) with a common origin to that of the innominate artery and left common carotid artery (formerly known as “bovine aortic arch” (with an incidence of up to 27%)) or one of multiple pathological conditions. The present study aimed to establish the feasibility and impact of prenatal anatomic arch variants’ diagnosis. A retrospective study of 271 fetal second- and third-trimester anomaly scans was performed in our tertiary center. Examinations that evaluated the sagittal aortic arch were included and the branching pattern was assessed. Additionally, a literature data search based on the terms “common origin of innominate artery and left common carotid artery”, “bovine arch”, “bovine aortic” and “aortic arch anomalies” was performed. Results that referred to prenatal AAAV were retained and the papers evaluated. In our study, the AAA incidence was 1.93%, with 4 out of 5 cases being arch type B. All cases had minor associated conditions but a good postnatal outcome. An anatomic aortic variant with a common IA and LCCa prenatal diagnosis was found in a small number of studies; most of the cases described in pediatric and adult series were related to cardiac surgery for stenting, aneurysm or thoracic-associated diseases. The incidence of AAAV varied from 6 to 27% depending on the population studied (highest incidence in African individuals). The variant was highly associated with aortic dissection, pulmonary and cerebral embolism and increased risks of incidents during surgery. Diagnosing AAAV during a routine anatomic scan is feasible and diagnoses can be made when anomaly scans are performed. Awareness of the condition is important for postnatal surgery when other cardiac anomalies are found; this can prevent accidents with simple changes to the patient’s lifestyle, and, in the case of surgery, means we can adopt the correct surgical approach.
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Affiliation(s)
- Liana Pleș
- Department of Obstetrics and Gynecology, ‘Carol Davila’ University of Medicine and Pharmacy, 020021 Bucharest, Romania;
- The “Bucur” Maternity, ‘Saint John’ Hospital, 040294 Bucharest, Romania
| | - Cătălin Cîrstoveanu
- Department of Pediatrics, ‘Carol Davila’ University of Medicine and Pharmacy, 020021 Bucharest, Romania;
- Pediatrics Department, ‘Maria Sklodowska Curie’ Emergency Children Clinical Hospital, 041451 Bucharest, Romania
| | - Romina-Marina Sima
- Department of Obstetrics and Gynecology, ‘Carol Davila’ University of Medicine and Pharmacy, 020021 Bucharest, Romania;
- The “Bucur” Maternity, ‘Saint John’ Hospital, 040294 Bucharest, Romania
- Correspondence: (R.-M.S.); (G.-P.G.)
| | - Gabriel-Petre Gorecki
- The “Bucur” Maternity, ‘Saint John’ Hospital, 040294 Bucharest, Romania
- Faculty of Medicine, ‘Titu Maiorescu’ University, 040441 Bucharest, Romania
- Correspondence: (R.-M.S.); (G.-P.G.)
| | - Radu Chicea
- Faculty of Medicine, ‘Lucian Blaga’ University of Sibiu, 550024 Sibiu, Romania;
| | - Bashar Haj Hamoud
- Department for Gynecology, Obstetrics and Reproductive Medicine, Saarland University Hospital, Kirrberger Straße 100, Building 9, 66421 Homburg, Germany;
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13
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Tello-Díaz C, Álvarez García B, Gil-Sala D, Riveiro Vilaboa M, Tenezaca-Sari X, Bellmunt S. Prevalence of common origin of the innominate and left carotid artery (CILCA) or bovine arch configuration in patients with blunt aortic injury. INT ANGIOL 2022; 41:170-176. [PMID: 35112824 DOI: 10.23736/s0392-9590.22.04793-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND The common origin of the innominate and left carotid artery (CILCA) have been described as a risk factor for thoracic aortic diseases (dissections and aneurysms), but its relationship with traumatic pathology of the thoracic aorta is not so well known. The aim of the present study is to describe the prevalence of CILCA among patients admitted to the hospital for high-energy polytrauma with aortic injury (BTAI) compared with a control group. METHODS Retrospective unicenter case-control study. Cases included all patients treated with BTAI between 1999-2020. The group of controls was patients admitted in our center for high-energy polytrauma between 2012-2017. Primary endpoint was to define the prevalence of CILCA among both groups and secondary endpoint was to measure the distance between brachiocephalic trunk (BCT) or left common carotid artery (LCCA) and left subclavian artery (LSA). Results were retrospectively reviewed by two investigators. RESULTS 49 patients in BTAI group and 248 patients in control group. With a good concordance between investigators, 21 patients with CILCA (42.9%) in the BTAI group versus 61 CILCA (24.6%) in the control group (p=0.009). The mean distance between BCT/LCCA and LSA among the cases with CILCA was 10.09 mm (SD = 2.89) and 7.48 mm (SD = 3.65) among cases with standard aortic arch (p = 0.010). CONCLUSIONS In the present study we found that CILCA configuration is more prevalent in patients with BTAI and the distance to left subclavian artery is longer.
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Affiliation(s)
- Cristina Tello-Díaz
- Vascular and Endovascular Surgery, Hospital Universitari Vall d'Hebron, Barcelona, Spain.,Vascular and Endovascular Surgery, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Beatriz Álvarez García
- Vascular and Endovascular Surgery, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Daniel Gil-Sala
- Vascular and Endovascular Surgery, Hospital Universitari Vall d'Hebron, Barcelona, Spain -
| | | | - Xavier Tenezaca-Sari
- Vascular and Endovascular Surgery, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Sergi Bellmunt
- Vascular and Endovascular Surgery, Hospital Universitari Vall d'Hebron, Barcelona, Spain
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14
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Bae SB, Kang EJ, Choo KS, Lee J, Kim SH, Lim KJ, Kwon H. Aortic Arch Variants and Anomalies: Embryology, Imaging Findings, and Clinical Considerations. J Cardiovasc Imaging 2022; 30:231-262. [PMID: 36280266 PMCID: PMC9592245 DOI: 10.4250/jcvi.2022.0058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 07/15/2022] [Accepted: 07/17/2022] [Indexed: 11/22/2022] Open
Abstract
There is a wide spectrum of congenital anomalies or variations of the aortic arch, ranging from non-symptomatic variations that are mostly detected incidentally to clinically symptomatic variations that cause severe respiratory distress or esophageal compression. Some of these may be accompanied by other congenital heart diseases or chromosomal anomalies. The widespread use of multidetector computed tomography (CT) in clinical practice has resulted in incidental detection of several variations of the aortic arch in adults. Thus, radiologists and clinicians should be aware of the classification of aortic arch anomalies and carefully look for imaging features associated with a high risk of clinical symptoms. Understanding the embryological development of the aortic arch aids in the classification of various subtypes of aortic arch anomalies and variants. For accurate diagnosis and precise evaluation of aortic arch anomalies, cross-sectional imaging modalities, such as multidetector CT or magnetic resonance imaging, play an important role by providing three-dimensional reconstructed images. In this review, we describe the embryological development of the thoracic aorta and discuss variations and anomalies of the aortic arch along with their clinical implications.
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Affiliation(s)
- Sang Bin Bae
- Department of Radiology, College of Medicine, Dong-A University, Busan, Korea
| | - Eun-Ju Kang
- Department of Radiology, College of Medicine, Dong-A University, Busan, Korea
| | - Ki Seok Choo
- Department of Radiology, Pusan National University School of Medicine, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Jongmin Lee
- Department of Radiology, Kyungpook National University School of Medicine, Daegu, Korea
| | - Sang Hyeon Kim
- Department of Radiology, College of Medicine, Dong-A University, Busan, Korea
| | - Kyoung Jae Lim
- Department of Radiology, College of Medicine, Dong-A University, Busan, Korea
| | - Heejin Kwon
- Department of Radiology, College of Medicine, Dong-A University, Busan, Korea
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15
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Marrocco-Trischitta MM, Alaidroos M, Romarowski RM, Milani V, Ambrogi F, Secchi F, Glauber M, Nano G. Aortic arch variant with a common origin of the innominate and left carotid artery as a determinant of thoracic aortic disease: a systematic review and meta-analysis. Eur J Cardiothorac Surg 2021; 57:422-427. [PMID: 31620770 DOI: 10.1093/ejcts/ezz277] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Revised: 08/29/2019] [Accepted: 09/16/2019] [Indexed: 12/15/2022] Open
Abstract
The aim of this study was to investigate whether the 'bovine' arch [i.e. arch variant with a common origin of the innominate and left carotid artery (CILCA)] is associated with an increased risk of thoracic aortic disease (TAD). The study was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The PubMed, EMBASE and Cochrane databases were searched to identify all case series reporting about CILCA arch and TAD between January 2008 and December 2018. A total of 485 studies were screened. The prevalence of CILCA arch was assessed, and data analysis was performed considering the difference in the risk of TAD for presence versus absence of CILCA arch. Eight studies enrolling 11 381 subjects were retrieved for quantitative analysis. The proportion of TAD among CILCA arch patients was higher [41.5% (28.1-56.4)] than the proportion among patients with standard arch configuration 34.0% (20.1-51.4). The odds ratio of developing TAD was 1.4 times higher in subjects with CILCA arch (95% confidence interval 1.068-1.839). The test for an overall effect indicated a significant association between CILCA arch and TAD (P < 0.015). The I2 was 78.1% with a value of P < 0.001 for heterogeneity. The Egger test did not show evidence of publication bias (P = 0.317). In conclusion, our meta-analysis supports the hypothesis of a correlation between the presence of CILCA arch and the onset of TAD. Our results warrant a specific and long-term surveillance for patients with this anatomical variant, and a thorough awareness of its potential clinical implications during image interpretation.
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Affiliation(s)
- Massimiliano M Marrocco-Trischitta
- Clinical Research Unit, Cardiovascular Department, IRCCS - Policlinico San Donato, Milan, Italy.,Vascular Surgery Unit, Cardiovascular Department, IRCCS - Policlinico San Donato, Milan, Italy
| | - Moad Alaidroos
- Clinical Research Unit, Cardiovascular Department, IRCCS - Policlinico San Donato, Milan, Italy.,Vascular Surgery Unit, Policlinico San Marco, Zingonia, Italy
| | - Rodrigo M Romarowski
- 3D and Computer Simulation Laboratory, IRCCS - Policlinico San Donato, Milan, Italy
| | - Valentina Milani
- Biostatistics Service, IRCCS - Policlinico San Donato, Milan, Italy
| | - Federico Ambrogi
- Biostatistics Service, IRCCS - Policlinico San Donato, Milan, Italy
| | - Francesco Secchi
- Division of Radiology, IRCCS - Policlinico San Donato, Milan, Italy
| | - Mattia Glauber
- Minimally Invasive Cardiac Surgery Department, Istituto Clinico Sant'Ambrogio, Milan, Italy
| | - Giovanni Nano
- Vascular Surgery Unit, Cardiovascular Department, IRCCS - Policlinico San Donato, Milan, Italy.,Department of "Scienze Biomediche per la Salute", University of Milan, Milan, Italy
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16
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Yoon WJ, Mani K, Wanhainen A, Rodriguez VM, Mell MW. Anatomic feasibility of off-the-shelf thoracic single side-branched endograft in patients with blunt traumatic thoracic aortic injury. J Vasc Surg 2021; 74:1456-1463.e2. [PMID: 33957230 DOI: 10.1016/j.jvs.2021.04.047] [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] [Received: 12/02/2020] [Accepted: 04/13/2021] [Indexed: 11/16/2022]
Abstract
OBJECTIVE The advent of thoracic single side-branched endograft (TSSBE) has provided a treatment option to obviate the need for open cervical debranching of the left subclavian artery (LSA), thereby enabling total endovascular incorporation of the LSA during thoracic endovascular aortic repair (TEVAR). In a previous study of patients with type B aortic dissection who had required zone 2 TEVAR, the anatomic feasibility of this device was demonstrated to range from 28% to 35%, suggesting limited applicability of the currently available designs. The objectives of the present study were twofold: (1) to evaluate the anatomic feasibility of TSSBE in blunt traumatic thoracic aortic injury (BTAI) patients who would require LSA revascularization; and (2) to describe the anatomic characteristics of the supra-aortic arch branches that could be used to improve future device design. METHODS A retrospective review was performed of BTAI patients who had undergone TEVAR at a single institution from November 2013 to October 2018. Preoperative computed tomography angiograms were analyzed using three-dimensional reconstruction to quantify the aortic diameter, distance and arc length between branch vessels, and the LSA diameter and length. We calculated the proportion of patients who had met all aortic and LSA anatomic requirements for TSSBE proposed by investigational protocols. We also assessed the effect of anatomic requirement modifications on device suitability. Finally, we assessed the local anatomic relationship between the supra-aortic branches. RESULTS A total of 41 patients (63% men; median age, 39 years; range, 23-88 years; 68% normal aortic arch pattern, 32% bovine aortic arch pattern) with BTAI who had required TEVAR involving the LSA and were, thus, considered potential candidates for TSSBE were included. Of the 41 patients, 13 (32%; 7 with a bovine aortic arch and 6 with a normal aortic arch) had met all proposed aortic and LSA anatomic requirements for TSSBE. An appropriate aortic diameter, LSA diameter, and LSA length to its first branch were observed in 100%, 95%, and 66% of the patients, respectively. An insufficient distance between the arch branch vessels, observed in 41%, was the most common exclusionary criterion. The median clock-face position of the LSA was 12:00 (interquartile range, 30 minutes) in the normal arch group and 11:45 (interquartile range, 15 minutes) in the bovine arch group. CONCLUSIONS Despite the numerous potential advantages of TSSBE, only 32% of patients with BTAI requiring LSA revascularization had met all the aortic and LSA anatomic requirements, justifying the need for additional designs. Better characterization and mapping of the aortic arch branches will improve future device design and application.
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Affiliation(s)
- William J Yoon
- Division of Vascular Surgery, Department of Surgery, University of California-Davis Medical Center, Sacramento, Calif; Division of Vascular Surgery, Department of Surgical Sciences, Uppsala University, Uppsala, Sweden.
| | - Kevin Mani
- Division of Vascular Surgery, Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Anders Wanhainen
- Division of Vascular Surgery, Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Victor M Rodriguez
- Division of Cardiothoracic Surgery, Department of Surgery, University of California-Davis Medical Center, Sacramento, Calif
| | - Matthew W Mell
- Division of Vascular Surgery, Department of Surgery, University of California-Davis Medical Center, Sacramento, Calif
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17
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Yousef S, Singh S, Alkukhun A, Alturkmani B, Mori M, Chen J, Mullan CW, Brooks CW, Assi R, Gruber PJ, Cortopassi I, Geirsson A, Vallabhajosyula P. Variants of the aortic arch in adult general population and their association with thoracic aortic aneurysm disease. J Card Surg 2021; 36:2348-2354. [PMID: 33855754 DOI: 10.1111/jocs.15563] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2021] [Revised: 02/25/2021] [Accepted: 03/17/2021] [Indexed: 01/16/2023]
Abstract
BACKGROUND Query a single institution computed tomography (CT) database to assess the prevalence of aortic arch anomalies in general adult population and their potential association with thoracic aortopathies. METHODS CT chest scan reports of patients aged 50-85 years old performed for any indication at a single health system between 2013 and 2016 were included in the analysis. Characteristics of patients with and without aortic arch anomalies were compared by t test and Fisher exact tests. Logistic regression analysis was performed to assess for independent risk factors of thoracic aortic aneurysm (TAA). RESULTS Of 21,336 CT scans, 603 (2.8%) described arch anomalies. Bovine arch (n = 354, 58.7%) was the most common diagnosis. Patients with arch anomalies were more likely to be female (p < .001), non-Caucasian(p < .001), and hypertensive (p < .001). Prevalence of TAA in arch anomalies group was 10.8% (n = 65) compared to 4.1% (n = 844) in the nonarch anomaly cohort (p < .001). The highest prevalence of thoracic aneurysm was associated with right-sided arch combined with aberrant left subclavian configuration (33%), followed by bovine arch (13%), and aberrant right subclavian artery (8.2%). On binary logistic regression, arch anomaly (OR = 2.85 [2.16-3.75]), aortic valve pathology (OR 2.93 [2.31-3.73]), male sex (OR 2.38 [2.01-2.80]), and hypertension (OR 1.47 [1.25-1.73]) were significantly associated with increased risk of thoracic aneurysm disease. CONCLUSIONS Reported prevalence of aortic arch anomalies by CT imaging in the older adult population is approximately 3%, with high association of TAA (OR = 2.85) incidence in this subgroup. This may warrant a more tailored surveillance strategy for aneurysm disease in this subpopulation.
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Affiliation(s)
- Sameh Yousef
- Division of Cardiac Surgery, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Saket Singh
- Division of Cardiac Surgery, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Abedalrazaq Alkukhun
- Division of Radiology, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Bilal Alturkmani
- Division of Radiology, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Makoto Mori
- Division of Cardiac Surgery, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Juliafayanne Chen
- Division of Cardiac Surgery, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Clancy W Mullan
- Division of Cardiac Surgery, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Cornell W Brooks
- Division of Cardiac Surgery, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Roland Assi
- Division of Cardiac Surgery, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Peter J Gruber
- Division of Cardiac Surgery, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Isabel Cortopassi
- Division of Radiology, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Arnar Geirsson
- Division of Cardiac Surgery, Yale University School of Medicine, New Haven, Connecticut, USA
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18
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Papakonstantinou NA, Rorris FP. Elective replacement of the ascending aorta: is the 5.5-cm threshold appropriate? The insidious, small aorta. Eur J Cardiothorac Surg 2021; 59:554-561. [PMID: 33226084 DOI: 10.1093/ejcts/ezaa387] [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: 06/27/2020] [Revised: 08/24/2020] [Accepted: 08/29/2020] [Indexed: 01/15/2023] Open
Abstract
OBJECTIVES As thoracic aortic aneurysm disease continues to cause significant morbidity and mortality in the general population, the cardiovascular community continues the search for the golden threshold of elective surgical replacement of the ascending aorta. METHODS Thoracic aortic aneurysm is a common disease, classified within the 20 most common causes of death in patients over 65 years old. Once aortic complications like dissection or rupture occur, they can prove fatal. Prophylactic surgical replacement of the ascending aorta remains the mainstay of treatment to prevent these complications. Current American and European guidelines agree that the threshold for the diameter for elective replacement of the ascending aorta in non-syndromic, asymptomatic aneurysmal disease is 5.5 cm. Overall, aortic dissection is related to poor prognosis, thus making early intervention paramount. RESULTS There is a critical size above which the risk of dissection or rupture becomes extremely high. However, a significant post-dissection increase in diameter is reported, thus rendering the predissection aortic diameter well below the current threshold for elective surgical replacement of the ascending aorta. Moreover, it is widely reported that the majority of acute aortic dissections would not meet the criteria for prophylactic surgery prior to dissection. Additionally, elective surgical ascending aortic replacement in the current era shows a significantly improved risk-benefit ratio, which justifies a more aggressive approach in the management of aortic aneurysmal disease. CONCLUSIONS As a result, there is a lot of discussion in the literature about the requirement of a leftward shifting of the surgical threshold for elective aortic replacement.
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Affiliation(s)
| | - Filippos-Paschalis Rorris
- Cardiovascular and Thoracic Surgery Department, General Hospital of Athens "Evangelismos", Athens, Greece
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19
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Significance of clamping distance in bovine and normal aortic arch patients. PROGRESS IN PEDIATRIC CARDIOLOGY 2020. [DOI: 10.1016/j.ppedcard.2020.101204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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20
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Goldsher YW, Salem Y, Weisz B, Achiron R, Jacobson JM, Gindes L. Bovine aortic arch: Prevalence in human fetuses. JOURNAL OF CLINICAL ULTRASOUND : JCU 2020; 48:198-203. [PMID: 31777971 DOI: 10.1002/jcu.22800] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Revised: 11/03/2019] [Accepted: 11/14/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVE "Bovine aortic arch" is the second most common variant of aortic arch branching, in which only two branches originate directly from the aorta. The prevalence of this condition has been reported in different studies to be around 6% in human fetuses and 11-27% in the adult population. In this study, we describe the prevalence of bovine aortic arch in fetuses, and assess the prevalence of concomitant fetal anomalies. METHODS A retrospective analysis of 417 fetuses between 15-40 weeks of gestation. Data regarding branching of the fetal aortic arch and other fetal anomalies were collected by fetal echocardiography and/or fetal ultrasonography. RESULTS A bovine arch was found in 20/413 fetuses (4.8%, 95CI 3.1-7.3%), of whom 14/310 (4.5%) had no fetal anomalies, and 6/77 (7.8%) exhibited minor changes (P = .241). None of the 26 fetuses with major anomalies had a bovine arch. CONCLUSION Fetuses in this study had a lower prevalence of bovine aortic arch than that previously reported in adults, most probably due to differences in the population examined. This study was underpowered to determine that bovine arch is a common anatomic variant, and is not associated with fetal anomalies.
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Affiliation(s)
- Yulia W Goldsher
- Department of Obstetrics and Gynecology, Ultrasound Unit, The Chaim Sheba Medical Center, Ramat Gan, Israel
| | - Yishai Salem
- Department of Pediatric Cardiology, The Chaim Sheba Medical Center, Ramat Gan, Israel
| | - Boaz Weisz
- Department of Obstetrics and Gynecology, Ultrasound Unit, The Chaim Sheba Medical Center, Ramat Gan, Israel
- Sackler school of medicine, Tel Aviv University, Tel Aviv, Israel
| | - Reuven Achiron
- Department of Obstetrics and Gynecology, Ultrasound Unit, The Chaim Sheba Medical Center, Ramat Gan, Israel
- Sackler school of medicine, Tel Aviv University, Tel Aviv, Israel
| | - Jeffrey M Jacobson
- Department of Pediatric Radiology, The Chaim Sheba Medical Center, Ramat Gan, Israel
| | - Liat Gindes
- Department of Obstetrics and Gynecology, Ultrasound Unit, Wolfson Medical Center, Holon, Israel
- Sackler school of medicine, Tel Aviv University, Tel Aviv, Israel
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21
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Marrocco-Trischitta MM, Alaidroos M, Romarowski RM, Secchi F, Righini P, Glauber M, Nano G. Geometric Pattern of Proximal Landing Zones for Thoracic Endovascular Aortic Repair in the Bovine Arch Variant. Eur J Vasc Endovasc Surg 2019; 59:808-816. [PMID: 31889656 DOI: 10.1016/j.ejvs.2019.11.019] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Revised: 10/14/2019] [Accepted: 11/12/2019] [Indexed: 01/09/2023]
Abstract
OBJECTIVE The aim was to investigate whether the "bovine" aortic arch (i.e. arch variant with a common origin of the innominate and left carotid artery (CILCA)) is associated with a consistent geometric configuration of proximal landing zones for thoracic endovascular aortic repair (TEVAR). METHODS Anonymised thoracic computed tomography (CT) scans of healthy aortas were reviewed to retrieve 100 cases of CILCA. Suitable cases were stratified according to type 1 and 2 CILCA, and also based on type of arch (I, II, and III). Further processing allowed calculation of angulation and tortuosity of the proximal landing zones. Centre lumen line lengths of each proximal landing zone were measured in a view perpendicular to the centre line. All geometric features were compared with those measured in healthy patients with a standard arch configuration (n = 60). Two senior authors independently evaluated the CT scans, and intra- and interobserver repeatability were assessed. RESULTS The 100 selected patients (63% male) were 71.4 ± 7.7 years old. Type 1 CILCA (62/100) was more prevalent than type 2 CILCA (38/100), and the two groups were comparable in age (p = .11). Zone 3 presented a severe angulation (i.e. > 60°), which was greater than in Zone 2 (p < .001), and a consistently greater tortuosity than Zone 2 (p = .003). This pattern did not differ between type 1 and type 2 CILCA. A greater tortuosity was also observed in Zone 0, which was related to increased elongation of the ascending aorta (i.e. Zone 0), than the standard configuration. The CILCA had an overall greater elongation, and Zone 2 also was specifically longer. When stratifying by type of arch, reversely from Type III to Type I, the CILCA presented a gradual flattening of its transverse tract, which entailed a consistent progressive elongation (p = .03) and kinking of the ascending aorta, with a significant increase of Zone 0 angulation to even a severe degree (p = .001). Also, from Type III to Type I, Zone 2 presented a progressively shorter length (p = .004), which was associated with increased tortuosity (p < .05). Mean intra- and interobserver differences for angulation measurements were 1.4° ± 6.8° (p = .17) and 2.0° ± 10.1° (p = .19), respectively. CONCLUSION CILCA presents a consistent and peculiar geometric pattern compared with standard arch configuration, which provides relevant information for TEVAR planning, and may have prognostic implications.
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Affiliation(s)
- Massimiliano M Marrocco-Trischitta
- Clinical Research Unit, IRCCS - Policlinico San Donato, Milan, Italy; Vascular Surgery Unit, IRCCS - Policlinico San Donato, Milan, Italy.
| | - Moad Alaidroos
- Clinical Research Unit, IRCCS - Policlinico San Donato, Milan, Italy; Vascular Surgery Unit, Policlinico San Marco, Zingonia, Italy
| | - Rodrigo M Romarowski
- 3D and Computer Simulation Laboratory, IRCCS - Policlinico San Donato, Milan, Italy
| | - Francesco Secchi
- Division of Radiology, IRCCS - Policlinico San Donato, Milan, Italy; Department of "Scienze Biomediche per la Salute", University of Milan, Italy
| | - Paolo Righini
- Vascular Surgery Unit, IRCCS - Policlinico San Donato, Milan, Italy
| | - Mattia Glauber
- Minimally Invasive Cardiac Surgery Unit, Istituto Clinico Sant'Ambrogio, Milan, Italy
| | - Giovanni Nano
- Vascular Surgery Unit, IRCCS - Policlinico San Donato, Milan, Italy; Department of "Scienze Biomediche per la Salute", University of Milan, Italy
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22
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Syperek A, Angermaier A, Kromrey ML, Hosten N, Kirsch M. The so-called "bovine aortic arch": a possible biomarker for embolic strokes? Neuroradiology 2019; 61:1165-1172. [PMID: 31372674 DOI: 10.1007/s00234-019-02264-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Accepted: 07/12/2019] [Indexed: 11/29/2022]
Abstract
PURPOSE To examine the prevalence of the so-called bovine aortic arch variation (common origin of the brachiocephalic trunk and the left common carotid artery) in embolic stroke patients, compared with a control group. METHODS Aortic arch branching patterns were retrospectively evaluated in 474 individuals with (n = 152) and without (n = 322) acute embolic stroke of the anterior circulation. Contrast-enhanced CT scans of the chest and neck (arterial contrast phase, 1-2-mm slice thickness) were used to evaluate aortic arch anatomy. The stroke cohort included 152 patients who were treated for embolic strokes of the anterior circulation between 2008 and 2018. A total of 322 randomly selected patients who had received thoracic CT angiographies within the same time frame were included as a control group. RESULTS With a prevalence of 25.7%, the bovine aortic arch variant was significantly more common among patients suffering from embolic strokes, compared with 17.1% of control patients (p = 0.039, OR = 1.67, 95%CI = 1.05-1.97). Stroke patients were more likely to show the bovine arch subtype B (left common carotid artery originating from the brachiocephalic trunk instead of the aortic arch) (10.5% vs. 5.0%, p = 0.039, OR = 2.25, 95%CI = 1.09-4.63), while subtype A (V-shaped common aortic origin of the brachiocephalic trunk and the left carotid) was similarly common in both groups. There was no significant difference regarding the frequency of other commonly observed variant branching patterns of the aortic arch. CONCLUSION The bovine aortic arch, particularly the bovine arch subtype B, was significantly more common among embolic stroke patients. This might be due to altered hemodynamic properties within the bovine arch.
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Affiliation(s)
- Annika Syperek
- Institute for Diagnostic Radiology and Neuroradiology, Greifswald University Hospital, Ferdinand-Sauerbruch-Straße, 17475, Greifswald, Germany.
| | - Anselm Angermaier
- Department of Neurology, Greifswald University Hospital, Greifswald, Germany
| | - Marie-Luise Kromrey
- Institute for Diagnostic Radiology and Neuroradiology, Greifswald University Hospital, Ferdinand-Sauerbruch-Straße, 17475, Greifswald, Germany
| | - Norbert Hosten
- Institute for Diagnostic Radiology and Neuroradiology, Greifswald University Hospital, Ferdinand-Sauerbruch-Straße, 17475, Greifswald, Germany
| | - Michael Kirsch
- Institute for Diagnostic Radiology and Neuroradiology, Greifswald University Hospital, Ferdinand-Sauerbruch-Straße, 17475, Greifswald, Germany
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Tawfik AM, Sobh DM, Ashamallah GA, Batouty NM. Prevalence and Types of Aortic Arch Variants and Anomalies in Congenital Heart Diseases. Acad Radiol 2019; 26:930-936. [PMID: 30266547 DOI: 10.1016/j.acra.2018.08.023] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Revised: 08/06/2018] [Accepted: 08/12/2018] [Indexed: 11/30/2022]
Abstract
RATIONALE AND OBJECTIVES Aortic arch (AA) variants and anomalies are important to recognize in patients with congenital heart disease (CHD) before surgery or intervention. The aim was to study the prevalence of AA anomalies and variants in patients with CHD compared to a control group. The secondary outcome was to report the associations between common variations of AA and specific types of CHD. MATERIALS AND METHODS After institutional review board approval, computed tomography studies of 352 CHD patients and control group of 400 consecutive computed tomography scans of the thorax were evaluated. The AA was assigned to one of seven common types, and their distribution was compared between CHD and control. The distribution of the AA anomalies and variants was evaluated as regard specific types of CHD and the visceroatrial situs. RESULTS Normal three-vessel branching pattern was the commonest in both groups, but was present in only 50.5% in the CHD compared to 68.5% in the control group, p < 0.00001. Right AA and aberrant right subclavian artery were significantly more common in CHD than control group (18.1% versus 0.25%, p < 0.00001) and (4.5% versus 0.25%, p = 0.0001), respectively. Direct aortic origin of left vertebral artery was insignificantly more common in CHD group (4.2% versus 2.7%, p = 0.258). Brachiobicephalic trunk was significantly more common in control than CHD group (27.7% versus 19.3%, p = 0.007). CONCLUSION Normal three-vessel AA was significantly less common in CHD. AA anomalies (right arch and aberrant right subclavian) were more common in CHD than control, while AA variants (brachiobicephalic trunk and direct aortic origin of left vertebral artery) were not.
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Affiliation(s)
- Ahmed M Tawfik
- Department of Diagnostic and Interventional Radiology, Faculty of Medicine, Mansoura University, 12 El-Gomhoreya Street, Mansoura 35112, Egypt.
| | - Donia M Sobh
- Department of Diagnostic and Interventional Radiology, Faculty of Medicine, Mansoura University, 12 El-Gomhoreya Street, Mansoura 35112, Egypt.
| | - Germeen A Ashamallah
- Department of Diagnostic and Interventional Radiology, Faculty of Medicine, Mansoura University, 12 El-Gomhoreya Street, Mansoura 35112, Egypt.
| | - Nihal M Batouty
- Department of Diagnostic and Interventional Radiology, Faculty of Medicine, Mansoura University, 12 El-Gomhoreya Street, Mansoura 35112, Egypt.
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Madjarov JM, Katz MG, Gubara SM, Madzharov S, Reames K, Madjarova S, Robicsek F. Single-stage hybrid repair of a ruptured Kommerell diverticulum associated with dextrorotation, bovine arch, and bicuspid aortic valve. J Cardiothorac Surg 2019; 14:117. [PMID: 31242919 PMCID: PMC6595610 DOI: 10.1186/s13019-019-0942-7] [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: 04/05/2019] [Accepted: 06/17/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND A strategy for the surgical repair of ruptured Kommerell diverticulum has not yet been established. The aim of this study is to demonstrate that this entity could be associated with a number of other cardiac anomalies and this lesion can be successfully treated by a hybrid approach. CASE PRESENTATION The patient, with a combination of ruptured Kommerell diverticulum, dextrorotation, bovine arch, and bicuspid aortic valve, underwent emergency surgery. A single stage hybrid surgical/endovascular repair including subclavian artery revascularization, aortic resection with open proximal anastomosis under circulatory arrest, endovascular stenting, and valve repair was performed. Histological studies indicated the presence of the aortic wall media degeneration. Postoperative course was uneventful and patient is free of symptoms during 2-year follow up. CONCLUSIONS Less invasive hybrid technique is safe and effective treatment option. Accumulated knowledge of Kommerell diverticulum has lead to understanding the best clinical treatment for this complicated aortic anomaly.
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Affiliation(s)
- Jeko M Madjarov
- Department of Cardiovascular Surgery, Sanger Heart & Vascular Institute, Charlotte, NC, USA
| | - Michael G Katz
- Department of Cardiology, Cardiovascular Research Center, Icahn School of Medicine at Mount Sinai, 1470 Madison Ave, Box 1030, New York, NY, 10029-6574, USA.
| | - Sarah M Gubara
- Department of Cardiology, Cardiovascular Research Center, Icahn School of Medicine at Mount Sinai, 1470 Madison Ave, Box 1030, New York, NY, 10029-6574, USA
| | - Svetozar Madzharov
- Department of Cardiovascular Surgery, Sanger Heart & Vascular Institute, Charlotte, NC, USA
| | - Kevin Reames
- Department of Cardiovascular Surgery, Sanger Heart & Vascular Institute, Charlotte, NC, USA
| | - Sophia Madjarova
- Department of Cardiovascular Surgery, Sanger Heart & Vascular Institute, Charlotte, NC, USA
| | - Francis Robicsek
- Department of Cardiovascular Surgery, Sanger Heart & Vascular Institute, Charlotte, NC, USA
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Brownstein AJ, Bin Mahmood SU, Saeyeldin A, Velasquez Mejia C, Zafar MA, Li Y, Rizzo JA, Dahl NK, Erben Y, Ziganshin BA, Elefteriades JA. Simple renal cysts and bovine aortic arch: markers for aortic disease. Open Heart 2019; 6:e000862. [PMID: 30774963 PMCID: PMC6350752 DOI: 10.1136/openhrt-2018-000862] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Revised: 06/26/2018] [Accepted: 07/03/2018] [Indexed: 12/03/2022] Open
Abstract
Objective This study aimed to assess the prevalence of thoracic aortic disease (TAD) and abdominal aortic aneurysms (AAA) among patients with simple renal cyst (SRC) and bovine aortic arch (BAA). Methods Through a retrospective search for patients who underwent both chest and abdominal CT imaging at our institution from 2012 to 2016, we identified patients with SRC and BAA and propensity score matched them to those without these features by age, gender and presence of hypertension, hyperlipidaemia, diabetes and chronic kidney disease. Results Of a total of 35 498 patients, 6366 were found to have SRC. Compared with the matched population without SRC, individuals with SRC were significantly more likely to have TAD (10.1% vs 3.9%), ascending aortic aneurysm (8.0% vs 3.2%), descending aortic aneurysm (3.3% vs 0.9%), type A aortic dissection (0.6% vs 0.2%), type B aortic dissection (1.1% vs 0.3%) and AAA (7.9% vs 3.3%). The 920 patients identified with BAA were significantly more likely to have TAD (21.8% vs 4.5%), ascending aortic aneurysm (18.4% vs 3.2%), descending aortic aneurysm (6.5% vs 2.0%), type A aortic dissection (1.4% vs 0.4%) and type B aortic dissection (2.4% vs 0.7%) than the matched population without BAA. SRC and BAA were found to be significantly associated with the presence of TAD (OR=2.57 and 7.69, respectively) and AAA (OR=2.81 and 2.56, respectively) on multivariable analysis. Conclusions This study establishes a substantial increased prevalence of aortic disease among patients with SRC and BAA. SRC and BAA should be considered markers for aortic aneurysm development.
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Affiliation(s)
- Adam J Brownstein
- Aortic Institute at Yale-New Haven Hospital, Yale School of Medicine, New Haven, Connecticut, USA.,Department of Medicine, Johns Hopkins Hospital and Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Syed Usman Bin Mahmood
- Aortic Institute at Yale-New Haven Hospital, Yale School of Medicine, New Haven, Connecticut, USA
| | - Ayman Saeyeldin
- Aortic Institute at Yale-New Haven Hospital, Yale School of Medicine, New Haven, Connecticut, USA
| | - Camilo Velasquez Mejia
- Aortic Institute at Yale-New Haven Hospital, Yale School of Medicine, New Haven, Connecticut, USA
| | - Mohammad A Zafar
- Aortic Institute at Yale-New Haven Hospital, Yale School of Medicine, New Haven, Connecticut, USA
| | - Yupeng Li
- Department of Political Science and Economics, Rowan University, Glassboro, New Jersey, USA
| | - John A Rizzo
- Aortic Institute at Yale-New Haven Hospital, Yale School of Medicine, New Haven, Connecticut, USA.,Department of Economics, Stony Brook University, Stony Brook, New York, USA.,Department of Family, Population and Preventive Medicine, Stony Brook University, Stony Brook, New York, USA
| | - Neera K Dahl
- Section of Nephrology, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Young Erben
- Aortic Institute at Yale-New Haven Hospital, Yale School of Medicine, New Haven, Connecticut, USA.,Section of Vascular and Endovascular Surgery, Yale School of Medicine, New Haven, Connecticut, USA
| | - Bulat A Ziganshin
- Aortic Institute at Yale-New Haven Hospital, Yale School of Medicine, New Haven, Connecticut, USA.,Department of Surgical Diseases No 2, Kazan State Medical University, Kazan, Russia
| | - John A Elefteriades
- Aortic Institute at Yale-New Haven Hospital, Yale School of Medicine, New Haven, Connecticut, USA
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Brownstein AJ, Rajaee S, Erben Y, Li Y, Rizzo JA, Lyall V, Mojibian H, Ziganshin BA, Elefteriades JA. Natural history of aneurysmal aortic arch branch vessels in a single tertiary referral center. J Vasc Surg 2018; 68:1631-1639.e1. [DOI: 10.1016/j.jvs.2018.03.412] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Accepted: 03/30/2018] [Indexed: 12/19/2022]
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Wu J, Qiu J, Jiang W, Qiu J, Zhang L, Zhao R, Yu C. Development and validation of a nomogram predicting the probability of type a aortic dissection at a diameter below 55 mm: A retrospective cohort study. Int J Surg 2018; 60:266-272. [PMID: 30496867 DOI: 10.1016/j.ijsu.2018.11.024] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Revised: 11/14/2018] [Accepted: 11/19/2018] [Indexed: 12/22/2022]
Abstract
INTRODUCTION The study aims to build and validate a nomogram for estimating the probability of patients developing type A aortic dissection at a diameter less than 55 mm. METHODS A primary cohort of 896 patients diagnosed with acute type A aortic dissection by computed tomography angiography (CTA) were used for model development, with data collected between January 2005 and March 2012. The subjects were assigned to two groups based on ascending aorta diameter (group A<55 mm, Group B ≥ 60 mm). Univariate and multivariate logistic regression analyses were employed for the development of the prediction model. Demographic factors, as well as clinical and imaging characteristics were taken into account. The resulting nomogram was evaluated for performance traits, e.g. calibration, discrimination and clinical usefulness. After internal validation, the nomogram was further assessed in a different cohort containing 385 consecutive subjects examined between January 2013 and December 2015. RESULTS The individualized prediction nomogram included 9 predictors derived from univariate and multivariable analyses, including gender, age, weight, hypertension, liver cyst, renal cyst, bicuspid aortic valve, and bovine arch. Those predictors were double confirmed with Lasso regression. Internal validation showed good discrimination of the model with area under the curve (AUC) of 0.854 and good calibration (Hosmer-Lemeshow test, P = 0.876). Application of the nomogram in the validation cohort still revealed good discrimination (AUC = 0.802) and good calibration (Hosmer-Lemeshow test, P = 0.398). Decision curve analysis demonstrated that the prediction nomogram was clinically useful. CONCLUSIONS The current work presents a prediction nomogram incorporating demographical data as well as clinical and imaging characteristics that could help identify patients who might develop type A aortic dissection at a diameter less than 55 mm with convenience.
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Affiliation(s)
- Jinlin Wu
- Departments of Cardiovascular Surgery, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Juntao Qiu
- Departments of Cardiovascular Surgery, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Wenxiang Jiang
- Departments of Cardiovascular Surgery, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jiawei Qiu
- Departments of Cardiovascular Surgery, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Liang Zhang
- Departments of Cardiovascular Surgery, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Rui Zhao
- Departments of Cardiovascular Surgery, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Cuntao Yu
- Departments of Cardiovascular Surgery, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
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Campobasso R, Condemi F, Viallon M, Croisille P, Campisi S, Avril S. Evaluation of Peak Wall Stress in an Ascending Thoracic Aortic Aneurysm Using FSI Simulations: Effects of Aortic Stiffness and Peripheral Resistance. Cardiovasc Eng Technol 2018; 9:707-722. [DOI: 10.1007/s13239-018-00385-z] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2018] [Accepted: 10/08/2018] [Indexed: 12/25/2022]
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29
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Ikeno Y, Koide Y, Matsueda T, Yamanaka K, Inoue T, Ishihara S, Nakayama S, Tanaka H, Sugimoto K, Okita Y. Anatomical variations of aortic arch vessels in Japanese patients with aortic arch disease. Gen Thorac Cardiovasc Surg 2018; 67:219-226. [PMID: 30178130 DOI: 10.1007/s11748-018-1001-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2018] [Accepted: 08/26/2018] [Indexed: 12/31/2022]
Abstract
OBJECTIVES The present study analyzed the prevalence of variations of the aortic arch branching in Japanese population, comparing patients with aortic arch disease with healthy controls. METHODS Between from October 1999 and December 2015, 815 Japanese patients with aortic arch disease defined as aortic arch aneurysm (diameter ≥ 45 mm) and aortic dissection (group A) underwent aortic arch surgery in our institution. As a control group, 1506 traumatic screened patients were enrolled (group C). RESULTS Aortic arch anomaly was diagnosed in 140 patients (17.2%) in the group A and in 222 patients (14.7%) in the group C (p = 0.125). Significant differences were found in the incidence of aberrant subclavian artery (A: 14 patients, 1.7%, vs. C: 8 patients, 0.5%, p = 0.006). Significantly more patients with aortic arch aneurysm in the group A had anomalies of the aortic arch compared with the group C (p = 0.009), including bovine aortic arch (p = 0.049) and aberrant subclavian artery (p < 0.001). In term of aneurysm location, bovine arch was detected in more patients with proximal arch aneurysm (15.7%, p = 0.043), whereas aberrant subclavian artery was in more patients with distal location (3.7%, p < 0.001). No difference was found in aortic arch anomaly in patients with acute or chronic dissection. CONCLUSION Aberrant subclavian artery was a significant maker of aortic arch disease in Japanese populations. Bovine arch was a risk maker of proximal arch aneurysm, and aberrant subclavian artery was a risk factor of distal arch aneurysm.
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Affiliation(s)
- Yuki Ikeno
- Division of Cardiovascular Surgery, Department of Surgery, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan.
| | - Yutaka Koide
- Division of Radiology, Kobe University, Kobe, Japan
| | - Takashi Matsueda
- Division of Cardiovascular Surgery, Department of Surgery, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Katsuhiro Yamanaka
- Division of Cardiovascular Surgery, Department of Surgery, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Takeshi Inoue
- Division of Cardiovascular Surgery, Department of Surgery, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Satoshi Ishihara
- Division of Emergency, Hyogo Emergency Medical Center, Kobe, Japan
| | | | - Hiroshi Tanaka
- Division of Cardiovascular Surgery, Department of Surgery, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | | | - Yutaka Okita
- Division of Cardiovascular Surgery, Department of Surgery, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
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Kahn CI, MacNeil M, Fanola CL, Whitney ER. Complex arterial patterning in an anatomical donor. TRANSLATIONAL RESEARCH IN ANATOMY 2018. [DOI: 10.1016/j.tria.2018.06.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
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Case Series of Aortic Arch Aneurysm in Patients with Bovine Arch Treated with Proximal Scalloped and Fenestrated Stent Graft. Cardiovasc Intervent Radiol 2018; 41:1648-1653. [PMID: 30120530 DOI: 10.1007/s00270-018-2058-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Accepted: 08/09/2018] [Indexed: 10/28/2022]
Abstract
PURPOSE The bovine arch is the most common variant of the aortic arch and occurs when the innominate artery shares a common origin with the left common carotid artery. We report an endovascular repair of aortic arch aneurysm in patients with a bovine arch using the Najuta proximal scalloped and fenestrated stent graft. MATERIALS AND METHODS Thoracic endovascular aneurysm repairs using the Najuta stent graft were performed at our facility. It was inserted and deployed at a zone 0 with precise positional adjustment of the scallop of the stent graft to the brachiocephalic trunk. RESULTS Overall, eight patients with bovine aortic arch were treated with fenestrated endovascular aneurysm repair. Technical success was 100% with no 30-day death. The follow-up period ranged from 7 to 29 (median 12) months. None of the patients had a stroke or paraplegia, and no endoleak was observed. All brachiocephalic trunks scalloped, and the left subclavian artery fenestrated vessels remained patent during the follow-up period. CONCLUSION The Najuta stent graft repair of aortic arch aneurysms in patients with a bovine arch is a safe and effective treatment option, with good immediate and short-term results.
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Tawfik AM, Sobh DM, Batouty NM. Common Origin of Brachiocephalic and Left Common Carotid Arteries: Proposal of New Terminology. AJNR Am J Neuroradiol 2018; 39:E86-E87. [PMID: 29700046 DOI: 10.3174/ajnr.a5659] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- A M Tawfik
- Department of Diagnostic and Interventional Radiology Faculty of Medicine, Mansoura University Mansoura, Egypt
| | - D M Sobh
- Department of Diagnostic and Interventional Radiology Faculty of Medicine, Mansoura University Mansoura, Egypt
| | - N M Batouty
- Department of Diagnostic and Interventional Radiology Faculty of Medicine, Mansoura University Mansoura, Egypt
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Toya N, Ohki T, Fukushima S, Shukuzawa K, Ito E, Akiba T. Fenestrated endovascular repair of aortic arch aneurysm in patients with bovine arch using the Najuta stent graft. J Vasc Surg Cases Innov Tech 2018; 4:148-151. [PMID: 29942907 PMCID: PMC6012989 DOI: 10.1016/j.jvscit.2018.01.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Accepted: 01/24/2018] [Indexed: 11/05/2022] Open
Abstract
We describe the case of a 74-year-old man with a thoracic aortic aneurysm with a bovine arch who underwent fenestrated endovascular repair of aortic arch aneurysm using the Najuta stent graft (Kawasumi Laboratories, Inc, Tokyo, Japan). He has had a previous endovascular aneurysm repair and femoropopliteal bypass for abdominal aortic aneurysm combined with peripheral arterial disease. The Najuta stent graft was inserted and deployed at zone 0 with delicate positional adjustment of the fenestration of the stent graft to the brachiocephalic trunk. There was no endoleak or complication. His postoperative course was uneventful. At 7-month follow-up, complete exclusion of the aneurysm was noted. The Najuta stent graft repair of aortic arch aneurysms is a safe and effective treatment option for patients with a bovine arch.
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Affiliation(s)
- Naoki Toya
- Division of Vascular Surgery, Department of Surgery, The Jikei University Kashiwa Hospital, Kashiwa, Japan
| | - Takao Ohki
- Division of Vascular Surgery, Department of Surgery, The Jikei University School of Medicine, Tokyo, Japan
| | - Soichiro Fukushima
- Division of Vascular Surgery, Department of Surgery, The Jikei University Kashiwa Hospital, Kashiwa, Japan
| | - Kota Shukuzawa
- Division of Vascular Surgery, Department of Surgery, The Jikei University School of Medicine, Tokyo, Japan
| | - Eisaku Ito
- Division of Vascular Surgery, Department of Surgery, The Jikei University Kashiwa Hospital, Kashiwa, Japan
| | - Tadashi Akiba
- Department of Surgery, The Jikei University Kashiwa Hospital, Kashiwa, Japan
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Shalhub S, Schäfer M, Hatsukami TS, Sweet MP, Reynolds JJ, Bolster FA, Shin SH, Reece TB, Singh N, Starnes BW, Jazaeri O. Association of variant arch anatomy with type B aortic dissection and hemodynamic mechanisms. J Vasc Surg 2018; 68:1640-1648. [PMID: 29804742 DOI: 10.1016/j.jvs.2018.03.409] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Accepted: 03/08/2018] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Congenital aortic arch variations are more common in patients with thoracic aortic disease for reasons unknown. Additionally, little is understood about their relation to type B aortic dissections (TBAD) specifically. We investigated the prevalence of variant aortic arch anatomy in patients with TBAD compared with controls. To understand the implications of how variant aortic arch anatomy may contribute to degenerative aortic disease, we compared flow hemodynamics of three variations of aortic arches using four-dimensional flow magnetic resonance imaging (4D flow MRI). METHODS Arch anatomy on computed tomography imaging was reviewed and compared between patients with TBAD and age/sex-matched controls free of aortic pathology. Arch variants were defined as follows: common origin of innominate and left common carotid artery (bovine arch), aberrant right subclavian artery, and right-sided aortic arch. Demographics, TBAD characteristics, and follow-up data were abstracted. Patients with TBAD with variant and conventional aortic arches were compared. Additionally, three matched healthy controls with conventional, bovine, and aberrant right subclavian artery arches underwent 4D flow MRI evaluation to assess if there were differences in flow patterns by arch type. Indices of regional hemodynamic wall sheer stress were compared. RESULTS Computed tomography scans of 185 patients with TBAD (mean age, 58.1 ± 12.4 years; 72.4% males; 71.4% Caucasian) and 367 controls (mean age, 62.5 ± 13.4 years; 67% males; 77.9% Caucasian) were reviewed. Variant arch anatomy was more prevalent in patients with TBAD (40.5% vs 24.5%; P < .001). In patients with TBAD, there were no differences in the mean age of presentation and descending thoracic aorta diameter among those with variant or conventional arch anatomy. Patients with TBAD with variant arch anatomy had a higher percentage of dissection related thoracic aortic repairs (54.7% vs 33.6%; P = .004) with repairs occurring predominantly in the acute phase. 4D flow MRI demonstrated a higher systolic wall shear stress along the inner curve of the bovine arch compared with the conventional aberrant right subclavian artery arches. CONCLUSIONS Variant aortic arch anatomy is significantly more prevalent in patients with TBAD. patients with TBAD with variant arch anatomy had a higher percentage of dissection-related aortic repair. Preliminary 4D flow MRI data show differences in hemodynamic flow patterns between variant and conventional arches. Studies of long-term outcomes based on arch anatomy may offer additional insight to TBAD genesis and possibly influence management decisions.
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Affiliation(s)
- Sherene Shalhub
- Division of Vascular Surgery, Department of Surgery, University of Washington, Seattle, Wash.
| | - Michal Schäfer
- Department of Cardiology, Children's Hospital Colorado, Aurora, Colo
| | - Thomas S Hatsukami
- Division of Vascular Surgery, Department of Surgery, University of Washington, Seattle, Wash
| | - Matthew P Sweet
- Division of Vascular Surgery, Department of Surgery, University of Washington, Seattle, Wash
| | - Jason J Reynolds
- Division of Vascular Surgery, Department of Surgery, University of Washington, Seattle, Wash
| | - Ferdia A Bolster
- Department of Radiology, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Susanna H Shin
- Division of Vascular Surgery, Department of Surgery, University of Washington, Seattle, Wash
| | - T Brett Reece
- School of Medicine, Division of Cardiothoracic Surgery, Department of Surgery, University of Colorado Denver, Aurora, Colo
| | - Niten Singh
- Division of Vascular Surgery, Department of Surgery, University of Washington, Seattle, Wash
| | - Benjamin W Starnes
- Division of Vascular Surgery, Department of Surgery, University of Washington, Seattle, Wash
| | - Omid Jazaeri
- School of Medicine, Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, University of Colorado Denver, Aurora, Colo
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Priya S, Thomas R, Nagpal P, Sharma A, Steigner M. Congenital anomalies of the aortic arch. Cardiovasc Diagn Ther 2018; 8:S26-S44. [PMID: 29850417 DOI: 10.21037/cdt.2017.10.15] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Congenital anomalies of the aortic arch include diverse subgroups of malformations that may be clinically silent or may present with severe respiratory or esophageal symptoms especially when associated with complete vascular rings. These anomalies may be isolated or may be associated with other congenital heart diseases. Volume rendered computed tomography (CT) and magnetic resonance angiography (MRA) help in preoperative surgical planning by providing information about the complex relationship of aortic arch and its branches to the trachea and esophagus. Three dimensional capabilities of both computed tomography angiography (CTA) and MRA are helpful in determining evidence of tracheal or esophageal compression or other high-risk features in patients with a complete vascular ring.
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Affiliation(s)
- Sarv Priya
- Division of Non-Invasive Cardiovascular Imaging, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Richard Thomas
- Division of Non-Invasive Cardiovascular Imaging, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Prashant Nagpal
- Department of Radiology, University of Iowa Hospitals and Clinics, Iowa, USA
| | - Arun Sharma
- Department of Cardiovascular Radiology, All India Institute of Medical Sciences, New Delhi, India
| | - Michael Steigner
- Division of Non-Invasive Cardiovascular Imaging, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
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Mylonas SN, Barkans A, Ante M, Wippermann J, Böckler D, Brunkwall JS. Prevalence of Bovine Aortic Arch Variant in Patients with Aortic Dissection and its Implications in the Outcome of Patients with Acute Type B Aortic Dissection. Eur J Vasc Endovasc Surg 2018; 55:385-391. [PMID: 29338980 DOI: 10.1016/j.ejvs.2017.12.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2017] [Accepted: 12/01/2017] [Indexed: 12/26/2022]
Abstract
OBJECTIVE/BACKGROUND To investigate the prevalence of bovine arch (BA) among patients with type A and B aortic dissection, and to provide insight into the implication of this variation on the outcome of patients with acute or subacute type B aortic dissection (a/sTBAD). METHODS This retrospective cohort analysis includes patients with a/sTBAD admitted between January 2006 and December 2016. Computed tomographic angiograms (CTAs) of patients referred because of type A aortic dissection were also re-evaluated with regard to the presence of BA. As a control group, 110 oncological patients who had undergone a chest CTA for disease staging during the study period were enrolled. A total of 154 patients with a/sTBAD and 168 with type A aortic dissection were identified during the study period. RESULTS An overall prevalence of 17.6% for BA variants was revealed. The comparison between patients with aortic dissection and the control group showed no statistically significant difference in BA prevalence (17.7% vs. 17.3%; p = 1.0). No statistically significant difference in BA prevalence was observed when comparing patients with type A aortic dissection with those with type B aortic dissection (16.6% vs. 18.8%; p = .66). During a median follow-up period of 27.8 months, 30 patients died. The mortality rate among patients presenting a BA variant was 34.5%, whereas among patients without, it was 16.0% (p = .04). Multivariate analysis revealed the presence of a BA as an independent predictor of mortality (adjusted odds ratio 3.4, 95% confidence interval 1.2-9.8). CONCLUSION The BA should be considered as a predictor of the outcome for patients with type B aortic dissection.
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Affiliation(s)
- Spyridon N Mylonas
- Department of Vascular and Endovascular Surgery, University of Cologne, Cologne, Germany.
| | - Arthurs Barkans
- Department of Vascular and Endovascular Surgery, University of Cologne, Cologne, Germany
| | - Marius Ante
- Department of Vascular and Endovascular Surgery, University of Heidelberg, Heidelberg, Germany
| | - Jens Wippermann
- Department of Cardiac and Thoracic Surgery, University of Cologne, Cologne, Germany
| | - Dietmar Böckler
- Department of Vascular and Endovascular Surgery, University of Heidelberg, Heidelberg, Germany
| | - Jan Sigge Brunkwall
- Department of Vascular and Endovascular Surgery, University of Cologne, Cologne, Germany
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Thoracic aortic aneurysm: unlocking the “silent killer” secrets. Gen Thorac Cardiovasc Surg 2017; 67:1-11. [DOI: 10.1007/s11748-017-0874-x] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Accepted: 11/21/2017] [Indexed: 12/25/2022]
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38
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Dumfarth J, Peterss S, Kofler M, Plaikner M, Ziganshin BA, Schachner T, Tranquilli M, Grimm M, Elefteriades JA. In DeBakey Type I Aortic Dissection, Bovine Aortic Arch Is Associated With Arch Tears and Stroke. Ann Thorac Surg 2017; 104:2001-2008. [DOI: 10.1016/j.athoracsur.2017.05.026] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2016] [Revised: 04/19/2017] [Accepted: 05/08/2017] [Indexed: 12/26/2022]
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39
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Condemi F, Campisi S, Viallon M, Troalen T, Xuexin G, Barker AJ, Markl M, Croisille P, Trabelsi O, Cavinato C, Duprey A, Avril S. Fluid- and Biomechanical Analysis of Ascending Thoracic Aorta Aneurysm with Concomitant Aortic Insufficiency. Ann Biomed Eng 2017; 45:2921-2932. [DOI: 10.1007/s10439-017-1913-6] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2017] [Accepted: 08/31/2017] [Indexed: 01/18/2023]
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40
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Dilatación de arco aórtico en la aortopatía asociada a válvula aórtica bicúspide: factores predictivos y seguimiento a medio plazo. CIRUGIA CARDIOVASCULAR 2017. [DOI: 10.1016/j.circv.2016.11.056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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41
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Clerici G, Giulietti E, Babucci G, Chaoui R. Bovine aortic arch: clinical significance and hemodynamic evaluation. J Matern Fetal Neonatal Med 2017; 31:2381-2387. [DOI: 10.1080/14767058.2017.1342807] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Graziano Clerici
- Centre of Reproductive and Perinatal Medicine, Santa Maria della Misericordia University Hospital, Perugia, Italy
| | - Eleonora Giulietti
- Department of Obstetrics/Gynecology, Santa Maria della Misericordia University Hospital, Perugia, Italy
| | - Giulia Babucci
- Department of Obstetrics/Gynecology, Santa Maria della Misericordia University Hospital, Perugia, Italy
| | - Rabih Chaoui
- Center for Prenatal Diagnosis and Human Genetics, Berlin, Germany
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42
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Morphologic features of the aortic arch and its branches in the adult Chinese population. J Vasc Surg 2016; 64:1602-1608.e1. [DOI: 10.1016/j.jvs.2016.05.092] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2016] [Accepted: 05/16/2016] [Indexed: 11/23/2022]
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43
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Idhrees M, Cherian VT, Menon S, Mathew T, Dharan BS, Jayakumar K. Bovine aortic arch with supravalvular aortic stenosis. Indian Heart J 2016; 68 Suppl 2:S83-S84. [PMID: 27751339 PMCID: PMC5067379 DOI: 10.1016/j.ihj.2015.07.007] [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: 10/31/2014] [Revised: 03/18/2015] [Accepted: 07/07/2015] [Indexed: 11/29/2022] Open
Abstract
A 5-year-old boy was diagnosed to have supravalvular aortic stenosis (SVAS). On evaluation of CT angiogram, there was associated bovine aortic arch (BAA). Association of BAA with SVAS has not been previously reported in literature, and to best of our knowledge, this is the first case report of SVAS with BAA. Recent studies show BAA as a marker for aortopathy. SVAS is also an arteriopathy. In light of this, SVAS can also possibly be a manifestation of aortopathy associated with BAA.
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Affiliation(s)
- Mohammed Idhrees
- Department of Cardiovascular and Thoracic Surgery, Sree Chitra Thirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India.
| | - Vijay Thomas Cherian
- Department of Cardiovascular and Thoracic Surgery, Sree Chitra Thirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
| | - Sabarinath Menon
- Department of Cardiovascular and Thoracic Surgery, Sree Chitra Thirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
| | - Thomas Mathew
- Department of Cardiovascular and Thoracic Surgery, Sree Chitra Thirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
| | - Baiju S Dharan
- Department of Cardiovascular and Thoracic Surgery, Sree Chitra Thirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
| | - K Jayakumar
- Department of Cardiovascular and Thoracic Surgery, Sree Chitra Thirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
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Chou AS, Ma WG, Mok SCM, Ziganshin BA, Peterss S, Rizzo JA, Tranquilli M, Elefteriades JA. Do Familial Aortic Dissections Tend to Occur at the Same Age? Ann Thorac Surg 2016; 103:546-550. [PMID: 27570161 DOI: 10.1016/j.athoracsur.2016.06.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Revised: 05/20/2016] [Accepted: 06/06/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND Prediction of the age at aortic dissection for family members of aortic dissection patients would enhance early detection and clinical management. We sought to determine whether these dissections tend to cluster by age in family members of the dissection patients. METHODS Ages at dissection were examined, including 51 sporadic dissectors (one dissection in family) and 39 familial dissectors (two or more dissections in family) from 16 families. Differences between sporadic and familial dissectors and relationships between ages at dissection in family members were analyzed by linear regression and clustering analysis. RESULTS Age at dissection was significantly younger in familial versus sporadic dissectors (54.1 ± 15.2 years versus 63.1±12.4 years, p = 0.002). Regression analysis of pairs of family member ages at dissection found a moderately close linear fit (R2 = 0.35). Cluster analysis indicated that age at onset of family dissectors increases as age of proband dissector increases. More than 50% of familial dissections occurred within 10 years of the median onset age for any given age decade. For familial dissectors with onset age of 30 to 49 years, 71% of other family member dissections also occurred at age 30 to 49 years, and no dissections occurred above the age of 63 years. For familial dissectors with onset age of 60 to 79 years, 80% of other family member dissections occurred beyond the age of 50 years. CONCLUSIONS Familial dissections occur earlier than sporadic dissections. Dissections cluster by age in families, and age at onset can predict the age of other dissectors. This finding argues for consideration of prophylactic resection of an aneurysm in family members approaching the age at onset of prior thoracic aortic dissection.
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Affiliation(s)
- Alan S Chou
- Aortic Institute at Yale-New Haven Hospital, Yale University School of Medicine, New Haven, Connecticut
| | - Wei-Guo Ma
- Aortic Institute at Yale-New Haven Hospital, Yale University School of Medicine, New Haven, Connecticut; Department of Cardiovascular Surgery, Beijing Anzhen Hospital of Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China
| | - Salvior C M Mok
- Aortic Institute at Yale-New Haven Hospital, Yale University School of Medicine, New Haven, Connecticut
| | - Bulat A Ziganshin
- Aortic Institute at Yale-New Haven Hospital, Yale University School of Medicine, New Haven, Connecticut; Department of Surgical Diseases #2, Kazan State Medical University, Kazan, Russia
| | - Sven Peterss
- Aortic Institute at Yale-New Haven Hospital, Yale University School of Medicine, New Haven, Connecticut; Department of Cardiac Surgery, University Hospital Munich, Ludwig-Maximilians-University, Munich, Germany
| | - John A Rizzo
- Aortic Institute at Yale-New Haven Hospital, Yale University School of Medicine, New Haven, Connecticut; Department of Economics and Department of Preventive Medicine, Stony Brook University, Stony Brook, New York
| | - Maryann Tranquilli
- Aortic Institute at Yale-New Haven Hospital, Yale University School of Medicine, New Haven, Connecticut
| | - John A Elefteriades
- Aortic Institute at Yale-New Haven Hospital, Yale University School of Medicine, New Haven, Connecticut.
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45
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Ziganshin BA, Elefteriades JA. Guilt by association: a paradigm for detection of silent aortic disease. Ann Cardiothorac Surg 2016; 5:174-87. [PMID: 27386404 DOI: 10.21037/acs.2016.05.13] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Detection of clinically silent thoracic aortic aneurysm (TAA) is challenging due to the lack of symptoms (until aortic rupture or dissection occurs). A large proportion of TAA are identified incidentally while imaging a patient for other reasons. However, recently several clinical "associates" of TAA have been described that can aid in identification of silent TAA. These "associates" include intracranial aneurysm, aortic arch anomalies, abdominal aortic aneurysm (AAA), simple renal cysts (SRC), bicuspid aortic valve, temporal arteritis, a positive family history of aneurysm disease, and a positive thumb-palm sign. In this article we examine these associates of TAA and the data supporting their involvement with asymptomatic TAA.
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Affiliation(s)
- Bulat A Ziganshin
- 1 Aortic Institute at Yale-New Haven Hospital, Yale University School of Medicine, New Haven, CT, USA ; 2 Department of Surgical Diseases # 2, Kazan State Medical University, Kazan, Russia
| | - John A Elefteriades
- 1 Aortic Institute at Yale-New Haven Hospital, Yale University School of Medicine, New Haven, CT, USA ; 2 Department of Surgical Diseases # 2, Kazan State Medical University, Kazan, Russia
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46
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Chou AS, Ziganshin BA, Charilaou P, Tranquilli M, Rizzo JA, Elefteriades JA. Long-term behavior of aortic intramural hematomas and penetrating ulcers. J Thorac Cardiovasc Surg 2016; 151:361-72, 373.e1. [DOI: 10.1016/j.jtcvs.2015.09.012] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2015] [Revised: 08/22/2015] [Accepted: 09/03/2015] [Indexed: 11/25/2022]
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47
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Ziganshin BA, Theodoropoulos P, Salloum MN, Zaza KJ, Tranquilli M, Mojibian HR, Dahl NK, Fang H, Rizzo JA, Elefteriades JA. Simple Renal Cysts as Markers of Thoracic Aortic Disease. J Am Heart Assoc 2016; 5:JAHA.115.002248. [PMID: 26746998 PMCID: PMC4859353 DOI: 10.1161/jaha.115.002248] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Abstract
Background Thoracic aortic aneurysm is usually a clinically silent disease; timely detection is largely dependent upon identification of clinical markers of thoracic aortic disease (TAD); (bicuspid aortic valve, intracranial aortic aneurysm, bovine aortic arch, or positive family history). Recently, an association of simple renal cysts (SRC) with abdominal aortic aneurysm and aortic dissection was established. The aim of our study was to evaluate the prevalence of SRC in patients with TAD in order to assess whether the presence of SRC can be used as a predictor of TAD. Methods and Results We evaluated the prevalence of SRC in 842 patients with TAD (64.0% males) treated at our institution from 2004 to 2013 and compared to a control group of patients (n=543; 56.2% males). Patients were divided into 4 groups: ascending aortic aneurysm (456; 54.2%); descending aortic aneurysm (86; 10.2%); type A aortic dissection (118; 14.0%); and type B aortic dissection (182; 21.6%). SRC were identified by abdominal computed tomography or magnetic resonance imaging of these patients. Prevalence of SRC is 37.5%, 57.0%, 44.1%, and 47.3% for patients with ascending aneurysm, descending aneurysm, type A dissection, and type B dissection, respectively. Prevalence of SRC in the control group was 15.3%. Prevalence of SRC was not significantly different between male and female aortic disease patients, despite reported general male predominance (2:1), which was also observed in our control group (1.7:1). Conclusions This study establishes an increased prevalence of SRC in patients with TAD. SRC can potentially be used as a marker for timely detection of patients at risk of TAD.
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Affiliation(s)
- Bulat A Ziganshin
- Aortic Institute at Yale-New Haven Hospital, Yale University School of Medicine, New Haven, CT (B.A.Z., P.T., M.N.S., K.J.Z., M.T., H.R.M., J.A.R., J.A.E.) Department of Surgical Diseases # 2, Kazan State Medical University, Kazan, Russia (B.A.Z.)
| | - Panagiotis Theodoropoulos
- Aortic Institute at Yale-New Haven Hospital, Yale University School of Medicine, New Haven, CT (B.A.Z., P.T., M.N.S., K.J.Z., M.T., H.R.M., J.A.R., J.A.E.)
| | - Mohammad N Salloum
- Aortic Institute at Yale-New Haven Hospital, Yale University School of Medicine, New Haven, CT (B.A.Z., P.T., M.N.S., K.J.Z., M.T., H.R.M., J.A.R., J.A.E.)
| | - Khaled J Zaza
- Aortic Institute at Yale-New Haven Hospital, Yale University School of Medicine, New Haven, CT (B.A.Z., P.T., M.N.S., K.J.Z., M.T., H.R.M., J.A.R., J.A.E.)
| | - Maryann Tranquilli
- Aortic Institute at Yale-New Haven Hospital, Yale University School of Medicine, New Haven, CT (B.A.Z., P.T., M.N.S., K.J.Z., M.T., H.R.M., J.A.R., J.A.E.)
| | - Hamid R Mojibian
- Aortic Institute at Yale-New Haven Hospital, Yale University School of Medicine, New Haven, CT (B.A.Z., P.T., M.N.S., K.J.Z., M.T., H.R.M., J.A.R., J.A.E.) Section of Vascular and Interventional Radiology, Yale University School of Medicine, New Haven, CT (H.R.M.)
| | - Neera K Dahl
- Section of Nephrology, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT (N.K.D.)
| | - Hai Fang
- China Center for Health Development Studies, Peking University, Beijing, China (H.F.)
| | - John A Rizzo
- Aortic Institute at Yale-New Haven Hospital, Yale University School of Medicine, New Haven, CT (B.A.Z., P.T., M.N.S., K.J.Z., M.T., H.R.M., J.A.R., J.A.E.) Departments of Economics and Preventive Medicine, Stony Brook University, Stony Brook, NY (J.A.R.)
| | - John A Elefteriades
- Aortic Institute at Yale-New Haven Hospital, Yale University School of Medicine, New Haven, CT (B.A.Z., P.T., M.N.S., K.J.Z., M.T., H.R.M., J.A.R., J.A.E.)
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48
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Prevalence of Bovine Aortic Arch Configuration in Adult Patients with and without Thoracic Aortic Pathology. Ann Vasc Surg 2016; 30:132-7. [DOI: 10.1016/j.avsg.2015.05.008] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2015] [Revised: 05/01/2015] [Accepted: 05/05/2015] [Indexed: 11/20/2022]
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49
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Elefteriades JA, Ziganshin BA. Paradigm for Detecting Silent Thoracic Aneurysm Disease. Semin Thorac Cardiovasc Surg 2016; 28:776-782. [PMID: 28417864 DOI: 10.1053/j.semtcvs.2016.10.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/06/2016] [Indexed: 02/07/2023]
Abstract
Thoracic aortic aneurysms (TAA) pose a serious detection challenge owing to their clinically silent nature. Only a small fraction of TAAs cause symptoms in patients. However, the mortality burden of this disease in the population is significant, given the high lethality of such complications as aortic rupture and dissection. Widespread screening for TAA has not been shown to be cost-effective. Therefore, currently most patients with a TAA are identified incidentally during an imaging study conducted for other reasons. Once a TAA diagnosis is established, prophylactic surgical treatment can safely be performed for aneurysms of the ascending aorta, aortic arch, and descending or thoracoabdominal aorta, thus preventing aneurysm-related death. To facilitate early detection of TAA, recent studies have identified several "associates" of TAA that may be useful in making a timely diagnosis. These "associates" include intracranial aneurysm, aortic arch anomalies, abdominal aortic aneurysm, simple renal cysts, bicuspid aortic valve, temporal arteritis, a positive family history of aneurysm disease, and a positive thumb-palm sign, among others. Although for many of these "associates" the underlying mechanism that would explain the association remains to be elucidated, the clinical correlation is strong enough to suggest screening patients with these findings for TAA. This article introduces the "Guilt by Association" paradigm for detection of silent thoracic aortic disease based on detection of clinical markers associated with this condition.
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Affiliation(s)
- John A Elefteriades
- Aortic Institute at Yale-New Haven Hospital, Yale University School of Medicine, New Haven, Connecticut.
| | - Bulat A Ziganshin
- Aortic Institute at Yale-New Haven Hospital, Yale University School of Medicine, New Haven, Connecticut; Department of Surgical Diseases #2, Kazan State Medical University, Kazan, Russia
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50
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Karahan O, Tezcan O, Demirtas S, Caliskan A, Yavuz C. Application of thoracic endovascular dissecting aneurysm repair for secondary type B aortic dissection. Cardiovasc J Afr 2015; 26:e10-2. [PMID: 26659649 PMCID: PMC4780023 DOI: 10.5830/cvja-2015-067] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2015] [Accepted: 08/25/2015] [Indexed: 11/27/2022] Open
Abstract
Type A aortic dissection is an emergency condition that requires immediate surgery. Graft replacement of the ascending aorta is the main treatment for this disorder. However, after ascending aortic replacement, the dissection flap may progress to the distal side (to the descending aorta) and a new intimal tear may develop. In this study, we report on a 66-year-old woman who had a history of ascending aortic replacement six months earlier. She was admitted to hospital with a new onset of back pain. Computed tomography revealed a new dissection tear originating from the distal side of the subclavian artery orifice. Thoracic endovascular dissecting aneurysm repair (TEVDAR) was carried out on the patient. Additional complications were not observed in the postoperative period. Complete cure was provided and the patient was discharged on the fourth day after the operation. TEVDAR may be safe and effective in preventing progression of the aortic flap and the formation of a new intimal tear in type A aortic dissections. Optional hybrid interventions could ameliorate the outcomes in aortic dissection cases.
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Affiliation(s)
- Oguz Karahan
- Medical School of Dicle University, Department of Cardiovascular Surgery, Diyarbakir, Turkey.
| | - Orhan Tezcan
- Medical School of Dicle University, Department of Cardiovascular Surgery, Diyarbakir, Turkey
| | - Sinan Demirtas
- Medical School of Dicle University, Department of Cardiovascular Surgery, Diyarbakir, Turkey
| | - Ahmet Caliskan
- Medical School of Dicle University, Department of Cardiovascular Surgery, Diyarbakir, Turkey
| | - Celal Yavuz
- Medical School of Dicle University, Department of Cardiovascular Surgery, Diyarbakir, Turkey
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