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Lu H, Lin Z, Chen Y, Lin F, Dai X, Chen L. Aortic remodeling after false lumen occlusion using an atrial septal occluder in chronic DeBakey IIIb aortic dissection. J Vasc Surg 2022; 75:1864-1871.e3. [PMID: 34995720 DOI: 10.1016/j.jvs.2021.12.060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Accepted: 12/06/2021] [Indexed: 10/19/2022]
Abstract
OBJECTIVE Retrograde false lumen flow through distal entry tears poses a challenge in the treatment of chronic DeBakey IIIb aneurysms. In the present report, we have described the feasibility and outcomes of false lumen occlusion using an atrial septal occluder (ASO) in chronic DeBakey IIIb dissection associated with a descending aneurysm. METHODS All the patients who had undergone thoracic endovascular aortic repair for chronic DeBakey IIIb aortic dissection at our institution from January 2014 to November 2020 were retrospectively reviewed. The primary endpoints were technical success and in-hospital postoperative results. The secondary endpoints included the midterm survival status and aortic remodeling outcomes. RESULTS A total of 37 patients (age, 56.24 ± 10.47 years) with persistent retrograde false lumen perfusion and aneurysm formation at the thoracic segment were treated using an ASO for false lumen occlusion. We achieved 100% technical success. No spinal cord ischemia or in-hospital death was observed. The median follow-up time was 36 months (interquartile range, 24-51 months). After the procedure, three patients (8.1%) had had an endoleak (type Ia in two patients and type II in one patients), and five patients had required late reintervention. The overall 5-year survival rate was 71%. One aortic-related death (2.7% of the total cohort) occurred during follow-up at 9 months. Complete thrombosis of the false lumen along the treated aortic segment was recorded postoperatively in 34 patients (91.9%) at the final follow-up using computed tomography angiography. In a mixed-effects model, a diameter analysis revealed that the thoracic true lumen diameter had increased and the thoracic false lumen diameter had decreased significantly (0.256 mm/mo, P < .001; and -0.512 mm/mo, P < .001, respectively). CONCLUSIONS The combination of standard thoracic endovascular aortic repair and false lumen occlusion using the ASO to promote false lumen thrombosis and remodeling in the treated segments is a technically feasible and effective alternative treatment of chronic DeBakey IIIb dissection with an associated descending aneurysm. This approach yielded satisfactory midterm survival outcomes and a low incidence of aortic-related death in our patients. However, further studies with more subjects and a prospective design should verify our findings before routine clinical implementation of this technique.
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Affiliation(s)
- Heng Lu
- Department of Cardiovascular Surgery, Union Hospital, Fujian Medical University, Fuzhou, People's Republic of China; Key Laboratory of Cardio-Thoracic Surgery, Fujian Medical University, Fuzhou, People's Republic of China.
| | - Zhiqin Lin
- Department of Cardiovascular Surgery, Union Hospital, Fujian Medical University, Fuzhou, People's Republic of China; Key Laboratory of Cardio-Thoracic Surgery, Fujian Medical University, Fuzhou, People's Republic of China
| | - Yi Chen
- Department of Cardiovascular Surgery, Union Hospital, Fujian Medical University, Fuzhou, People's Republic of China
| | - Feng Lin
- Department of Cardiovascular Surgery, Union Hospital, Fujian Medical University, Fuzhou, People's Republic of China
| | - Xiaofu Dai
- Department of Cardiovascular Surgery, Union Hospital, Fujian Medical University, Fuzhou, People's Republic of China
| | - Liangwan Chen
- Department of Cardiovascular Surgery, Union Hospital, Fujian Medical University, Fuzhou, People's Republic of China; Key Laboratory of Cardio-Thoracic Surgery, Fujian Medical University, Fuzhou, People's Republic of China
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Nugraha RA, Amshar M, Batubara EAD, Siddiq T, Indriani S, Adiarto S. Descending Aorta Diameters as Predictor of Late Adverse Outcomes in Patients with Uncomplicated Type B Aortic Dissection: A Systematic Review and Meta-Analysis. Ann Vasc Surg 2021; 80:333-344. [PMID: 34780948 DOI: 10.1016/j.avsg.2021.10.033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 10/04/2021] [Accepted: 10/04/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND A subset of patients with uncomplicated type B aortic dissection (uTBAD) has been shown to possess higher risk of experiencing late adverse outcomes. Therefore, we conducted an analysis to investigate the role of descending aorta diameters, including total descending aorta diameter and false lumen diameter, as predictor of late adverse outcomes in patients with uTBAD. METHODS A systematic search was performed through Pubmed, ClinicalKey, ScienceDirect, and Cochrane Library to identify relevant studies. Our primary outcome was the composite late adverse events following their first episode of hospitalization. All meta-analyses were performed using Review Manager version 5.4. RESULTS A total of 2,339 (male 68.8%) patients from a total of 15 cohorts were included in our analysis. During follow-up period, there were 655 (27.3%) and 149 (6.3%) cases of late adverse events and mortality, respectively. Patients with higher initial descending aorta diameter were at higher risk of developing late adverse events (RR 2.99 [2.60, 3.44]; P < 0.001) and mortality (RR 3.15 [2.34, 4.25]; P <0.001) throughout follow-up period. Maximum false lumen diameter at the initial presentation seemed to significantly be associated with late adverse events (RR 1.87 [1.46, 2.39]; P <0.001) but not with mortality (RR 2.55 [0.81-8.00; P = 0.11). CONCLUSION Descending aorta diameters, particularly maximum initial descending aorta diameter, is a good and helpful predictor of late adverse outcomes in patients with uTBAD.
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Affiliation(s)
- Raka Aldy Nugraha
- Department of General Medicine, Universitas Indonesia Hospital, Depok, West Java, Indonesia.
| | - Mohamed Amshar
- Department of General Medicine, Universitas Indonesia Hospital, Depok, West Java, Indonesia
| | | | - Taofan Siddiq
- Department of Cardiology and Vascular Medicine, Faculty of Medicine Universitas Indonesia/National Cardiovascular Center Harapan Kita, Jakarta, Indonesia
| | - Suci Indriani
- Department of Cardiology and Vascular Medicine, Faculty of Medicine Universitas Indonesia/National Cardiovascular Center Harapan Kita, Jakarta, Indonesia
| | - Suko Adiarto
- Department of Cardiology and Vascular Medicine, Faculty of Medicine Universitas Indonesia/National Cardiovascular Center Harapan Kita, Jakarta, Indonesia
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Spanos K, Kölbel T. Role of Endoluminal Techniques in the Management of Chronic Type B Aortic Dissection. Cardiovasc Intervent Radiol 2020; 43:1808-1820. [PMID: 32601718 PMCID: PMC8490267 DOI: 10.1007/s00270-020-02566-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Accepted: 06/20/2020] [Indexed: 12/22/2022]
Abstract
In recent guidelines of international societies, the most frequent indication for treatment after chronic type B aortic dissection (cTBAD) is aneurysmal dilatation. Endovascular repair is recommended in patients with moderate to high surgical risk or with contraindications to open repair. During the last decade, many advances have been made in the field of endovascular techniques and devices. The aim of this article is to address the current status of endoluminal techniques for the management of cTBAD including standard thoracic endovascular repair, new devices, fenestrated and branched abdominal aortic devices and false lumen occlusion techniques.
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Affiliation(s)
- Konstantinos Spanos
- German Aortic Center Hamburg, Department of Vascular Medicine, University Heart Center, University Hospital Hamburg Eppendorf, Martinistr. 52, 20246, Hamburg, Germany.
| | - Tilo Kölbel
- German Aortic Center Hamburg, Department of Vascular Medicine, University Heart Center, University Hospital Hamburg Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
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Kazimierczak A, Rynio P, Jędrzejczak T, Mokrzycki K, Samad R, Brykczyński M, Rybicka A, Zair L, Gutowski P. Expanded Petticoat technique to promote the reduction of contrasted false lumen volume in patients with chronic type B aortic dissection. J Vasc Surg 2019; 70:1782-1791. [PMID: 31521400 DOI: 10.1016/j.jvs.2019.01.073] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Accepted: 01/31/2019] [Indexed: 12/01/2022]
Abstract
OBJECTIVE This study examined the outcomes of our novel concept of expanded provisional extension to induce complete attachment strategy (Petticoat) for safety, durability, and remodeling of chronic type B dissections. METHODS Twenty patients with chronic type B aortic dissection with aneurysmal degeneration qualified for an expanded Petticoat strategy (stent graft in the thoracic, plus additional distal bare stent into the abdominal and infrarenal aorta, followed by parallel stent grafts into common iliac arteries). Computed tomography was performed preoperatively and at 1, 6, and 12 months after surgery. RESULTS The primary technical success was 100%. The 30-day mortality rate was 0%. At 12 months, favorable aortic remodeling and complete false lumen (FL) thrombosis were noted as 100% in the thoracic and infrarenal aorta. The volume of contrast-enhanced FL decreased from 186 ± 75.4 mL all along the dissection preoperatively (range, 70-360 mL), to 6.32 ± 5.4 mL postoperatively (range, 0.0-19.6 mL) and was only observed in the visceral aorta (P = .000089). Despite persistent flow in a small area of the FL, the maximal aortic size was stable in follow-up. Neither paraplegia nor visceral branch occlusion were noted in the follow-up. CONCLUSIONS The treatment of aortic dissections with an expanded Petticoat strategy seems to be safe and offers good early results. It significantly reduced the volume of contrast enhanced FL. Further investigation of any subsequent results will be necessary.
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Affiliation(s)
- Arkadiusz Kazimierczak
- Department of Vascular Surgery, Pomeranian Medical University of Szczecin, Szczecin, Poland.
| | - Paweł Rynio
- Department of Vascular Surgery, Pomeranian Medical University of Szczecin, Szczecin, Poland
| | - Tomasz Jędrzejczak
- Cardiac Surgery Department, Pomeranian Medical University of Szczecin, Szczecin, Poland
| | - Krzysztof Mokrzycki
- Cardiac Surgery Department, Pomeranian Medical University of Szczecin, Szczecin, Poland
| | - Rabih Samad
- Department of Vascular Surgery, Pomeranian Medical University of Szczecin, Szczecin, Poland
| | - Mirosław Brykczyński
- Cardiac Surgery Department, Pomeranian Medical University of Szczecin, Szczecin, Poland
| | - Anita Rybicka
- Department of Nursing, Pomeranian Medical University of Szczecin, Szczecin, Poland
| | - Labib Zair
- Department of General Surgery and Transplantation, Pomeranian Medical University of Szczecin, Szczecin, Poland
| | - Piotr Gutowski
- Department of Vascular Surgery, Pomeranian Medical University of Szczecin, Szczecin, Poland
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Moradi M, Mirfasihi RS. Is there any association between aortic root rotation angle and aortic dissection? Indian J Thorac Cardiovasc Surg 2019; 36:181-185. [PMID: 33061123 DOI: 10.1007/s12055-019-00859-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Revised: 07/15/2019] [Accepted: 07/18/2019] [Indexed: 10/26/2022] Open
Abstract
Introduction Thoracic aortic dissection is a probable fatal condition that requires early diagnosis and management. The underlying etiology of this disorder is an important issue that has not been completely responded yet. In the current study, the association between aortic root rotation and ascending aortic dissection has been assessed. Methods This is a non-randomized retrospective case-control study conducted on twenty-five cases referring with ascending aortic dissection and seventy-five controls that underwent computed tomography (CT) angiography for reasons other than aortic dissection. Aortic root rotation angle and aortic diameter for both cases and controls were measured and then compared. Results There was no significant difference regarding age and gender distribution (P value = 0.22 and 0.38 respectively) between patients in case and control groups. The mean values of aortic root rotation angle and aortic diameter in cases were 22.5 ± 10.5° and 43.1 ± 12.5 mm versus 15.7 ± 10.7° and 30.7 ± 5.3 mm in controls (P value = 0.007 and 0.001 respectively). Direct relation was found between aortic root rotation angle and aortic diameter (P value = 0.007, r = 0.276). Mean of aortic root rotation angle was significantly higher in females (P value = 0.02). No association between cases' age with either aortic root rotation angle or aortic diameter was found (P value = 0.33, r = 0.098, and P value = 0.085, r = 0.173 respectively). Conclusion Based on the findings of the current study, aortic root rotation angle was independently in direct association with thoracic aortic dissection. In addition, females had higher aortic root rotation angles.
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Affiliation(s)
- Maryam Moradi
- Department of Radiology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Raheleh Sadat Mirfasihi
- Department of Radiology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
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He X, Liu X, Liu W, Wang B, Liu Y, Li Z, Wang T, Tan R, Gao B, Zeng H. Association between Diabetes and Risk of Aortic Dissection: A Case-Control Study in a Chinese Population. PLoS One 2015; 10:e0142697. [PMID: 26562793 PMCID: PMC4643043 DOI: 10.1371/journal.pone.0142697] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2015] [Accepted: 10/26/2015] [Indexed: 12/17/2022] Open
Abstract
Background It is well-recognized that diabetes represents a powerful independent risk factor for cardiovascular diseases. However, very few studies have investigated the relationship between diabetes and risk of aortic dissection (AD). Aim The aim of this case-control study was to evaluate the association between diabetes and risk of AD in Chinese population. Methods A hospital-based case-control study, consisting of 2160 AD patients and 4320 controls, was conducted in a Chinese population. Demographic, clinical characteristics and risk factors were collected. Diabetes rate of patients with overall AD, Stanford type A AD and type B AD group was compared with that of corresponding matched control groups. Logistic regression analysis was used to estimate the odds ratios (OR) and 95% confidence intervals (95% CI) for relationship between diabetes and AD risk. Results The prevalence of diabetes was lower in AD cases than that of control subjects, whether it is the overall AD, type A AD or type B AD group (4.7% vs. 10.0%, 2.9% vs. 8.8%, 5.9% vs. 10.9%, all P<0.001). Furthermore, in multivariate model, diabetes was found to be associated with lower AD risk, which not only applies to the overall AD (OR = 0.2, 95%CI: 0.15–0.26), but also type A AD (OR = 0.12, 95% CI: 0.07–0.20) and type B AD (OR = 0.25, 95%CI: 0.18–0.33). Conclusions We observed the paradoxical inverse relationship between DM and risk of AD in the Chinese population. These results suggest diabetes may play a protective role in the development of AD. However, further studies are needed to enrich related evidence, especially with regard to underlying mechanisms for these trends.
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Affiliation(s)
- Xingwei He
- Department of Cardiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xintian Liu
- Department of Cardiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Wanjun Liu
- Department of Cardiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Bei Wang
- Department of Cardiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yujian Liu
- Department of Cardiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Zhuxi Li
- Department of Cardiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Tao Wang
- Department of Cardiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Rong Tan
- Department of Cardiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Bo Gao
- Department of Cardiology, Suizhou Affiliated Hospital of Hubei Medical College, Suizhou, China
| | - Hesong Zeng
- Department of Cardiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- * E-mail:
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Ayça B, Rakıcı T, Atıcı Y, Avsar M, Yuksel Y, Akın F, Okuyan E, Hakan Dinckal M. Adult degenerative scoliosis associated with increased aortic diameter and plaque burden and composition. Vascular 2015. [PMID: 26223527 DOI: 10.1177/1708538115597371] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
OBJECTIVE In this study, we aimed to investigate the relationship between adult degenerative scoliosis (ADS) and the aortic plaques and diameters. METHOD We included 219 patients with ADS and 100 control patients without ADS. Diameters of ascending, arch, descending and abdominal aorta and number, localization and types of the aortic plaques, and the Cobb angles of all patients were measured from computed tomography (CT) images. We divided the patients with ADS into three groups according to the Cobb angle, and divided them into four groups according to level of spine deformity. RESULTS The patients with ADS had a larger aorta and more aortic plaques (both, p < 0.001). The patients with ADS had more fibro-fatty and mix plaques (both, p < 0.001). The patients with severe ADS had larger diameters of the ascending and arch of the aorta (p = 0.026 and p = 0.027, respectively). The patients with the main thoracic curve had a larger ascending aorta and the patients with a thoracolumbar curve had more aortic plaques (p = 0.035 and p = 0.029, respectively). In multivariate regression analysis, the ADS was an independent risk factor for both aortic dilatation (>3.6 cm) and aortic plaque build-up (both, p < 0.001). CONCLUSION The ADS may be a risk factor for aortic dilatation and aortic atherosclerosis.
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Affiliation(s)
- Burak Ayça
- Department of Cardiology, Bağcılar Education and Research Hospital, Istanbul, Turkey
| | - Taşkın Rakıcı
- Department of Radiology, Samatya Education and Research Hospital, Istanbul, Turkey
| | - Yunus Atıcı
- Department of Orthopaedics and Traumatology, Metin Sabancı Baltalimanı Bone Disease Education and Research Hospital, Istanbul, Turkey
| | - Murat Avsar
- Department of Cardiology, Bağcılar Education and Research Hospital, Istanbul, Turkey
| | - Yasin Yuksel
- Department of Cardiology, Samatya Education and Research Hospital, Istanbul, Turkey
| | - Fatih Akın
- School of Medicine, Department of Cardiology, Muğla Sıtkı Kocman University, Muğla, Turkey
| | - Ertugrul Okuyan
- Department of Cardiology, Bağcılar Education and Research Hospital, Istanbul, Turkey
| | - M Hakan Dinckal
- Department of Cardiology, Bağcılar Education and Research Hospital, Istanbul, Turkey
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