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Kato M. Interventions in Acute or Subacute Phase for Type B Aortic Dissection. Ann Vasc Dis 2024; 17:120-127. [PMID: 38919329 PMCID: PMC11196166 DOI: 10.3400/avd.ra.24-00012] [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: 02/04/2024] [Accepted: 02/07/2024] [Indexed: 06/27/2024] Open
Abstract
The treatment strategy for acute and subacute Stanford type B aortic dissection has changed significantly since the advent of thoracic endovascular aortic repair (TEVAR). Indication for invasive treatment: In addition to the conventional complicated cases (rupture or malperfusion case), the indication for invasive treatment now includes cases with refractory hypertension, persistent or recurrent pain, large aortic diameter, and other conditions that are considered to have a poor prognosis with conservative treatment. Treatment methods: TEVAR is the first choice for acute, subacute, and early chronic-stage treatment, and when this is not possible, other techniques (fenestration and graft replacement) are chosen. Treatment timing: The timing of invasive treatment should be emergent in life-threatening conditions (for rupture or malperfusion case) and immediate in symptomatic cases, while in other cases, preemptive TEVAR is considered appropriate on a scheduled timing within 6 months of onset. (This is a translation of Jpn J Vasc Surg 2023; 32: 157-163.).
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Affiliation(s)
- Masaaki Kato
- Department of Cardiovascular Surgery, Morinomiya Hospital, Osaka, Osaka, Japan
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2
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Lau C, Soletti GJ, Lawrence KM, Rahouma M, Iannacone E, Gambardella I, Gaudino M, Girardi LN. Contemporary outcomes of open repair of acute complicated type B aortic dissection. J Vasc Surg 2023; 78:593-601.e4. [PMID: 37211141 DOI: 10.1016/j.jvs.2023.04.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 04/03/2023] [Accepted: 04/06/2023] [Indexed: 05/23/2023]
Abstract
OBJECTIVE Open repair of acute complicated type B aortic dissection (ACTBAD), required when endovascular repair is not possible, is historically considered high-risk. We analyze our experience with this high-risk cohort compared with the standard cohort. METHODS We identified consecutive patients undergoing descending thoracic or thoracoabdominal aortic aneurysm (TAAA) repair from 1997 to 2021. Patients with ACTBAD were compared with those having surgery for other reasons. Logistic regression was used to identify associations with major adverse events (MAEs). Five-year survival and competing risk of reintervention were calculated. RESULTS Of 926 patients, 75 (8.1%) had ACTBAD. Indications included rupture (25/75), malperfusion (11/75), rapid expansion (26/75), recurrent pain (12/75), large aneurysm (5/75), and uncontrolled hypertension (1/75). The incidence of MAEs was similar (13.3% [10/75] vs 13.7% [117/851], P = .99). Operative mortality was 5.3% (4/75) vs 4.8% (41/851) (P = .99). Complications included tracheostomy (8%, 6/75), spinal cord ischemia (4%, 3/75), and new dialysis (2.7%, 2/75). Renal impairment, urgent/emergent operation, forced expiratory volume in 1 second ≤50%, and malperfusion were associated with MAEs, but not ACTBAD (odds ratio: 0.48, 95% confidence interval [CI]: [0.20-1.16], P = .1). At 5 and 10 years, there was no difference in survival (65.8% [95% CI: 54.6-79.2] vs 71.3% [95% CI: 67.9-74.9], P = .42, and 47.3% [95% CI: 34.5-64.7] vs 53.7% [95% CI: 49.3-58.4], P = .29, respectively) or 10-year reintervention (12.5% [95% CI: 4.3-25.3] vs 7.1% [95% CI: 4.7-10.1], P = .17, respectively). CONCLUSIONS In an experienced center, open repair of ACTBAD can be performed with low rates of operative mortality and morbidity. Outcomes similar to elective repair are achievable even in high-risk patients with ACTBAD. In patients unsuitable for endovascular repair, transfer to a high-volume center experienced in open repair should be considered.
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Affiliation(s)
- Christopher Lau
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY.
| | | | - Kendall M Lawrence
- Division of Cardiovascular Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Mohamed Rahouma
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY
| | - Erin Iannacone
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY
| | | | - Mario Gaudino
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY
| | - Leonard N Girardi
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY
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3
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Salas-González MD, Bermejo LM, González-Rodríguez LG, Lozano-Estevan MDC, Ortega RM, López-Sobaler AM. Adherence to 24-h movement guidelines in Spanish schoolchildren and its association with insulin resistance: a cross-sectional study. Front Public Health 2023; 11:1146580. [PMID: 37492132 PMCID: PMC10365640 DOI: 10.3389/fpubh.2023.1146580] [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: 01/17/2023] [Accepted: 06/19/2023] [Indexed: 07/27/2023] Open
Abstract
Introduction Being more active, being less sedentary, and sleeping enough are associated with adequate body weight and adiposity in children. However, few researchers have analyzed these different lifestyle behaviors and the adherence to 24 h movement guidelines with respect to insulin resistance (IR) at school age. Therefore, we aimed to analyse the association between the adherence to 24 h movement guidelines (physical activity, sedentary time, sleep) and IR in Spanish schoolchildren. Methods A cross-sectional study of 839 children (8-13 years, 51.1% girls) were studied. Anthropometric, biochemical, and lifestyle behavioral data were collected. IR was defined as HOMA-IR>3.16. Compliance with the 24 h movement guidelines were defined as ≥60 min/day of moderate and/or vigorous physical activity, < 120 min/day of screen time, and 9-11 h/day of sleep time. Associations between adherence to the 24 h movement guidelines and IR were performed by multivariate logistic regression analyses. Results The IR in our sample was 5.0%, being higher in girls. Compliance with physical activity or screen time, but not with sleep recommendations, was associated with lower fasting glucose, fasting insulin, and HOMA-IR values. A low adherence to 24 h movement guidelines was associated with a higher risk of IR (odds ratio (95% CI): 2.150 [1.089-4.247]), especially in girls (odds ratio (95% CI): 2.800 [1.180-6.645]). Conclusion Higher physical activity levels and lower screen times were associated with a lower risk of IR in schoolchildren, underlining the importance of adhering to as many healthy lifestyle recommendations as possible.
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Affiliation(s)
- María Dolores Salas-González
- Grupo de Investigación VALORNUT, Departamento de Nutrición y Ciencia de los Alimentos, Facultad de Farmacia, Universidad Complutense de Madrid, Madrid, Spain
| | - Laura M. Bermejo
- Grupo de Investigación VALORNUT, Departamento de Nutrición y Ciencia de los Alimentos, Facultad de Farmacia, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - Liliana G. González-Rodríguez
- Grupo de Investigación VALORNUT, Departamento de Nutrición y Ciencia de los Alimentos, Facultad de Farmacia, Universidad Complutense de Madrid, Madrid, Spain
| | - María Del Carmen Lozano-Estevan
- Grupo de Investigación VALORNUT, Departamento de Nutrición y Ciencia de los Alimentos, Facultad de Farmacia, Universidad Complutense de Madrid, Madrid, Spain
| | - Rosa M. Ortega
- Grupo de Investigación VALORNUT, Departamento de Nutrición y Ciencia de los Alimentos, Facultad de Farmacia, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - Ana M. López-Sobaler
- Grupo de Investigación VALORNUT, Departamento de Nutrición y Ciencia de los Alimentos, Facultad de Farmacia, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
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Matsuda H. Current management of acute type B dissection in 2021. Asian Cardiovasc Thorac Ann 2023; 31:37-41. [PMID: 35473408 DOI: 10.1177/02184923221097172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The rationale for thoracic endovascular aortic repair (TEVAR) for type B aortic dissection depends on the phase of disease: acute phase, which is 'complicated', subacute to early chronic phase, which requires 'preemptive TEVAR' and chronic phase, which entails 'prevention of further dilatation and rupture'. Low operative mortality and morbidity after TEVAR for complicated acute type B aortic dissection have been reported with significant improvement during midterm survival. 'Retrograde' type A dissection, which can be described as type B0,X (X>3) according to a new reporting standard, has reportedly been treated with TEVAR with less invasiveness. TEVAR is the first and possibly the only effective strategy for acute type B dissection, so that expansion of indications for type B0,X, as described in the new reporting standard has been validated.
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Affiliation(s)
- Hitoshi Matsuda
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
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Kano M, Iwahashi T, Nishibe T, Kamiya K, Ogino H. Spinal Cord Ischemia in the Setting of Acute Type B Aortic Dissection: Successful Rescue with Thoracic Endovascular Aortic Repair. Vasc Endovascular Surg 2021; 56:102-106. [PMID: 34541969 DOI: 10.1177/15385744211045156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
We report 2 cases of successful thoracic endovascular aortic repair (TEVAR) for acute type B aortic dissection (ABAD) complicated with spinal cord ischemia (SCI). Case 1. A 70-year-old gentleman found with an uncomplicated ABAD with false lumen occluded, developed SCI shortly after admission during the initial medical management. Cerebrospinal fluid drainage (CSFD) was initiated followed by emergent TEVAR. SCI improved, and the patient was discharged. Case 2. A 52-year-old gentleman developed uncomplicated ABAD with patent false lumen. 5 hours after admission, he developed SCI during the initial medical management. Emergent TEVAR was performed followed by CSFD, and the SCI improved before discharge. These cases prompted us to address prompt TEVAR for primary entry closure and true lumen dilatation with postoperative hypertensive management to relieve the dynamic obstruction of the segmental arteries responsible for the compromised spinal cord circulation in complicated ABAD.
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Affiliation(s)
- Masaki Kano
- Department of Cardiovascular Surgery, 13112Tokyo Medical University, Tokyo, Japan
| | - Toru Iwahashi
- Department of Cardiovascular Surgery, 13112Tokyo Medical University, Tokyo, Japan
| | - Toshiya Nishibe
- Department of Cardiovascular Surgery, 13112Tokyo Medical University, Tokyo, Japan
| | - Kentaro Kamiya
- Department of Cardiovascular Surgery, 13112Tokyo Medical University, Tokyo, Japan
| | - Hitoshi Ogino
- Department of Cardiovascular Surgery, 13112Tokyo Medical University, Tokyo, Japan
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Mid- and Long-Term Effects of Endovascular Surgery and Hybrid Procedures for Complex Aortic Diseases. BIOMED RESEARCH INTERNATIONAL 2019; 2019:3247615. [PMID: 31119164 PMCID: PMC6500686 DOI: 10.1155/2019/3247615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Revised: 02/13/2019] [Accepted: 03/17/2019] [Indexed: 11/17/2022]
Abstract
Objective To assess the efficacy and short- and mid-term results of endovascular surgery and hybrid surgical procedures in treatment of complex aortic dissection. Methods Clinical data of 90 patients with complex aortic dissection admitted from June 2012 to June 2018 were retrospectively analyzed. Among the patients, 60 cases were male and 30 cases were female, and their ages were ranged from 32 to 79, with an average age of 55 years old; different endovascular techniques and/or hybrid procedures were performed in these patients. Results Technical success rate was 100% for the entire group of patients. Type I endoleak occurred in 8 patients immediately after stent-graft placement, which in 2 cases disappeared after a proximal Cuff placement, and the other cases received no special treatment. Follow-up was conducted from 1 month to 72 months, with an average of 36.3 months, and no stent-graft migration or organ ischemia was noted. In the follow-up patients, no type I endoleak occurred but type II endoleak was found in 2 cases, which were cured without treatment; no patient had paraplegia. Conclusion Endovascular surgery and hybrid procedures have demonstrable mid- and long-term efficacy in treatment of complex aortic diseases. However, this conclusion still requires multicenter, large-sample studies to further confirm.
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Lau C, Leonard JR, Iannacone E, Gaudino M, Girardi LN. Surgery for Acute Presentation of Thoracoabdominal Aortic Disease. Semin Thorac Cardiovasc Surg 2018; 31:11-16. [PMID: 30071280 DOI: 10.1053/j.semtcvs.2018.07.018] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Accepted: 07/24/2018] [Indexed: 01/16/2023]
Abstract
Thoracoabdominal aortic aneurysms are most commonly asymptomatic until there is either an impending aortic catastrophe or one that has already occurred. While open surgery remains the gold-standard method for repair, modern technology has led to the development of less invasive endovascular devices and techniques. We provide an expert review of open and endovascular therapies for 3 highly lethal thoracoabdominal aortic emergencies in order to highlight expectations for both short- and long-term outcomes in an era of evolving technology and improvements in patient evaluation and postoperative care. Open repair of ruptured thoracoabdominal aortic aneurysms is associated with a dramatic increase in all postoperative complications, even in specialized aortic surgery centers. Mycotic thoracic aortic aneurysms are highly lethal if surgical treatment is not initiated quickly as they have a propensity toward rapid growth and fatal rupture. Thoracic endovascular aortic repair is well-suited for the treatment of acute complicated type B aortic dissection with outcomes superior to open repair in some centers. Acute aortic events associated with thoracoabdominal aneurysms represent technically challenging situations that require rapid diagnosis and treatment to avoid a fatal outcome. Endovascular techniques have evolved as a viable alternative therapy for acute complicated type B aortic dissection or as a bridge to more definitive repair in the setting of infection or rupture.
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Affiliation(s)
- Christopher Lau
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, New York
| | - Jeremy R Leonard
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, New York
| | - Erin Iannacone
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, New York
| | - Mario Gaudino
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, New York
| | - Leonard N Girardi
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, New York.
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Rossi UG, Ierardi AM, Carrafiello G, Cariati M. Images in Vascular Medicine. Aortic dissection: Mercedes-Benz sign. Vasc Med 2018; 23:572. [PMID: 30035673 DOI: 10.1177/1358863x18788715] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Umberto G Rossi
- 1 Department of Diagnostic Imaging - Interventional Radiology Unit, E.O. Galliera Hospital, Genova, Italy.,2 Advanced Technology Department of Diagnostic and Therapy - Radiology and Interventional Radiology Unit, ASST Santi Paolo and Carlo - San Carlo Borromeo Hospital, Milano, Italy
| | - Anna Maria Ierardi
- 3 Diagnostic and Interventional Radiology Department, ASST Santi Paolo and Carlo - San Paolo Hospital, University of Milan, Milano, Italy
| | - Gianpaolo Carrafiello
- 3 Diagnostic and Interventional Radiology Department, ASST Santi Paolo and Carlo - San Paolo Hospital, University of Milan, Milano, Italy
| | - Maurizio Cariati
- 2 Advanced Technology Department of Diagnostic and Therapy - Radiology and Interventional Radiology Unit, ASST Santi Paolo and Carlo - San Carlo Borromeo Hospital, Milano, Italy
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Yuan X, Mitsis A, Ghonem M, Iakovakis I, Nienaber CA. Conservative management versus endovascular or open surgery in the spectrum of type B aortic dissection. J Vis Surg 2018; 4:59. [PMID: 29682469 DOI: 10.21037/jovs.2018.02.15] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Accepted: 02/09/2018] [Indexed: 01/16/2023]
Abstract
Background Type B aortic dissection is a life-threatening acute aortic condition often with acute ischemic signs or symptoms. With initial management focusing on alleviating malperfusion and pain, and avoiding propagation of dissection or rupture both systolic blood and pulse pressure should be reduced initially by an aggressive medical approach. In the setting of persistent signs of complications endovascular strategies have replaced open surgery and led to a fourfold increase in early survival and better long-term outcomes. Methods An electronic health database search was performed on articles published between January 2006 and July 2017. Publications were included in this review if (I) the index aortic pathology was type B aortic (distal) dissection; (II) when medical management, open surgical replacement or thoracic endovascular aortic repair were among those options; (III) when at least one of all basic outcome criteria such as survival, spinal cord ischemia and cerebrovascular accident was reported; (IV) when ≥15 serial patients were included. A total of 62 studies were eligible and analysed. Results Our manuscript has summarized data collected over 12 years on management specific outcomes in the setting of distal aortic dissection and provides an up-to-date interpretation of the published evidence. For complicated cases, treated acutely, the 30-day or in-hospital mortality was 7.3% when managed by endovascular means, whereas the pooled rate for 30-day or in-hospital mortality was 19.0% when subjected to open repair. For acute uncomplicated type B dissection usually treated with blood pressure lowering medications, the pooled 30-day or in-hospital mortality rate was 2.4%. Survival rates at 5 years averaged at 60% (40% mortality). Freedom from any aortic event ranged from 34.0% to 83.9%, underlining an inherent risk of progression and late complications. For chronic complicated type B dissection, the rates of stroke, paraplegia and operative mortality following endovascular repair ranged from 5% to 13%, 2% to 13% and 2 to 13%, respectively, while 5-year survival rates after open repair ranged from 60% to 90%. In chronic uncomplicated type B dissection almost 90% of patients survive initial hospitalization and were subjected to medical management with a 5-year survival of 50-80%. However, up to 20-55% of medically treated patients develop aneurysmal degeneration after 5 years with an unknown risk of rupture. Conclusions Currently, the less invasive strategy of endovascular repair (as compared to open surgery) provides improved 30-day or in-hospital survival in the setting of complicated acute type B aortic dissection and may seek broad application. Open surgical aortic reconstruction should be left to experienced aortic centres if endovascular management is not an option.
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Affiliation(s)
- Xun Yuan
- Cardiology and Aortic Centre, Royal Brompton & Harefield NHS Foundation Trust and Imperial College, London, UK
| | - Andreas Mitsis
- Cardiology and Aortic Centre, Royal Brompton & Harefield NHS Foundation Trust and Imperial College, London, UK
| | - Mohammed Ghonem
- Cardiology and Aortic Centre, Royal Brompton & Harefield NHS Foundation Trust and Imperial College, London, UK
| | - Ilias Iakovakis
- Cardiac Surgery Department, Royal Brompton & Harefield NHS Foundation Trust and Imperial College, London, UK
| | - Christoph A Nienaber
- Cardiology and Aortic Centre, Royal Brompton & Harefield NHS Foundation Trust and Imperial College, London, UK
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Sultan S, Kavanagh EP, Stefanov F, Sultan M, Elhelali A, Costache V, Diethrich E, Hynes N. Endovascular management of chronic symptomatic aortic dissection with the Streamliner Multilayer Flow Modulator: Twelve-month outcomes from the global registry. J Vasc Surg 2017; 65:940-950. [PMID: 28342521 DOI: 10.1016/j.jvs.2016.09.059] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Accepted: 09/04/2016] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Reported are initial 12-month outcomes of patients with chronic symptomatic aortic dissection managed by the Streamliner Multilayer Flow Modulator (SMFM; Cardiatis, Isnes, Belgium). Primary end points were freedom from rupture- and aortic-related death, and reduction in false lumen index. Secondary end points were patency of great vessels and visceral branches, and freedom of stroke, paraplegia, and renal failure. METHODS Out of 876 SMFM implanted globally, we have knowledge of 542. To date, 312 patients are maintained in the global registry, of which 38 patients were identified as having an aortic dissection (12.2%). Indications included 35 Stanford type B dissections, two Stanford type A and B dissections, and one mycotic Stanford type B dissection. RESULTS There were no reported ruptures or aortic-related deaths. All cause survival was 85.3% Twelve-month freedom from neurologic events was 100%, and there were no incidences of end-organ ischemia, paraplegia or renal insult. Morphologic analysis exhibited dissection remodeling by a reduction in longitudinal length of the dissected aorta, and false lumen volume. A statistically significant reduction in false lumen index (P = .016) at 12 months, and a borderline significant increase in true lumen volume (P = .053) confirmed dissection remodeling. CONCLUSIONS The SMFM is an option in management of complex pan-aortic dissection. Results highlight SMFM implantation leads to dissection stabilization with no further aneurysm progression, and no retrograde type A dissection. Thoracic endovascular aneurysm repair by SMFM ensued in freedom from aortic rupture, neurologic stroke, paraplegia and renal failure. Further analysis of the global registry data will inform long-term outcomes.
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Affiliation(s)
- Sherif Sultan
- Department of Vascular and Endovascular Surgery, Western Vascular Institute, Galway University Hospital, National University of Ireland, Galway, Ireland; Department of Vascular and Endovascular Surgery, Galway Clinic, Doughiska, Galway, Ireland.
| | - Edel P Kavanagh
- Department of Vascular and Endovascular Surgery, Galway Clinic, Doughiska, Galway, Ireland
| | - Florian Stefanov
- Department of Mechanical and Industrial Engineering, Galway Medical Technologies Center (GMedTech), Galway Mayo Institute of Technology, Galway, Ireland
| | - Mohamed Sultan
- Department of Vascular and Endovascular Surgery, Western Vascular Institute, Galway University Hospital, National University of Ireland, Galway, Ireland
| | - Ala Elhelali
- Department of Vascular and Endovascular Surgery, Western Vascular Institute, Galway University Hospital, National University of Ireland, Galway, Ireland; Department of Mechanical and Industrial Engineering, Galway Medical Technologies Center (GMedTech), Galway Mayo Institute of Technology, Galway, Ireland
| | - Victor Costache
- Department of Cardio-Vascular Surgery, European Clinic Polisano Hospital, Sibiu, Romania
| | | | - Niamh Hynes
- Department of Vascular and Endovascular Surgery, Western Vascular Institute, Galway University Hospital, National University of Ireland, Galway, Ireland; Department of Vascular and Endovascular Surgery, Galway Clinic, Doughiska, Galway, Ireland
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Szeberin Z, Dósa E, Fehérvári M, Csobay-Novák C, Pintér N, Entz L. Early and Long-term Outcome after Open Surgical Suprarenal Aortic Fenestration in Patients with Complicated Acute Type B Aortic Dissection. Eur J Vasc Endovasc Surg 2015; 50:44-50. [DOI: 10.1016/j.ejvs.2014.12.028] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2014] [Accepted: 12/22/2014] [Indexed: 12/14/2022]
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Akutsu K, Yoshino H, Tobaru T, Hagiya K, Watanabe Y, Tanaka K, Koyama N, Yamamoto T, Nagao K, Takayama M. Acute type B aortic dissection with communicating vs. non-communicating false lumen. Circ J 2015; 79:567-73. [PMID: 25746541 DOI: 10.1253/circj.cj-14-0828] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND In practice, patients with acute aortic dissection (AAD) are generally divided into 2 groups according to the status of the false lumen: non-communicating or communicating. The similarities and differences between the 2 groups, however, have not been fully determined in a large population. METHODS AND RESULTS: We studied 502 patients with Stanford type B AAD. Clinical background at symptom onset was compared, and similarities and differences characterized, for patients with non-communicating (NC group, n=288) vs. communicating (C group, n=214) false lumens. Time of day (00.00-06.00 hours, 06.00-12.00 hours, 12.00-18.00 hours, and 18.00-24.00 hours) and extent of physical activity (extreme exertion, slight exertion, at rest, and sleeping) at symptom onset were similar between groups. Patients in the NC group were older (mean age, 71±11 years vs. 64±14 years, P<0.01) and had lower prevalence of distally extended aortic dissection (26% vs. 8%, P<0.01) and deaths in hospital (2% vs. 7%, P=0.011) than those in the C group. CONCLUSIONS At symptom onset, clinical circumstances and physical activity were similar between the groups, and old age and a background of DeBakey IIIa aortic dissection may be associated with determination of false lumen status. The outcome in the NC group was better than in the C group.
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Affiliation(s)
- Koichi Akutsu
- Tokyo CCU Network Scientific Committee; Division of Cardiovascular Intensive Care, Nippon Medical School Hospital, 1-1-5 Sendagi, Bunkyo-ku 113-8603.
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Tagami T, Matsui H, Horiguchi H, Fushimi K, Yasunaga H. Thoracic aortic injury in Japan--nationwide retrospective cohort study. Circ J 2014; 79:55-60. [PMID: 25399756 DOI: 10.1253/circj.cj-14-0916] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND The epidemiology of traumatic thoracic aortic injury has not been reported in many countries, so we investigated the current trends in Japan. METHODS AND RESULTS Patients with traumatic thoracic aortic injury from July 2007 to March 2013 were identified using a Japanese nationwide administrative database, the Diagnosis Procedure Combination inpatient database. The trends in crude in-hospital mortality and proportion of endovascular repair use among patients with repair were evaluated over time. A total of 617 incident cases of thoracic aortic injury were identified at 234 hospitals, and categorized into endovascular repair (n=126), open repair (n=76), and non-repair (n=415) groups. The in-hospital mortality rate for each of these groups was 5.6%, 15.8%, and 45.3%, respectively. The in-hospital survival rate was higher in the endovascular repair group than in the open repair group (log-rank χ(2)=4.9; P=0.03). Although the crude in-hospital mortality did not change significantly during the study period (Mantel-Haenszel trend test, P=0.10), the proportion of endovascular repair use among all repair cases increased significantly (P<0.001). CONCLUSIONS The results of the present nationwide study suggest that the endovascular approach to treatment of thoracic aortic injury in Japan gained in popularity from 2007 to 2012.
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Affiliation(s)
- Takashi Tagami
- Department of Clinical Epidemiology and Health Economics, School of Public Health, Graduate School of Medicine, The University of Tokyo, Tokyo; Department of Emergency and Critical Care Medicine, Nippon Medical School, Tokyo.
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Kurumisawa S, Sugaya A, Akutsu H, Takazawa I, Ohki SI, Misawa Y. Delayed visceral ischemia induced by type B aortic dissection. Acute Med Surg 2014; 2:131-133. [PMID: 29123708 PMCID: PMC5667216 DOI: 10.1002/ams2.87] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2014] [Accepted: 08/10/2014] [Indexed: 11/17/2022] Open
Abstract
Case A 56‐year‐old man presented with a sudden severe abdominal pain 13 days after the onset of type B acute aortic dissection. Chest computed tomography revealed type B aortic dissection, and the true lumen was narrowed by the expanding false lumen. Blood flow through the celiac trunk, superior mesenteric artery, and left renal artery was reduced. Blood flow through the distal abdominal aorta and bilateral femoral arteries was clearly recognized. Laboratory findings such as transaminases were rapidly worsening. Outcome The patient underwent emergency fenestration of the abdominal aorta and recovered without organ failure. Conclusions Rapidly worsening laboratory findings led us to emergency operation with successful results. Serial monitoring of laboratory findings is the key for adequate timing of operation.
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Affiliation(s)
- Soki Kurumisawa
- Division of Cardiovascular Surgery Jichi Medical University Shimotsuke Japan
| | - Akira Sugaya
- Division of Cardiovascular Surgery Jichi Medical University Shimotsuke Japan
| | - Hirohiko Akutsu
- Division of Cardiovascular Surgery Jichi Medical University Shimotsuke Japan
| | - Ippei Takazawa
- Division of Cardiovascular Surgery Jichi Medical University Shimotsuke Japan
| | - Shin-Ichi Ohki
- Division of Cardiovascular Surgery Jichi Medical University Shimotsuke Japan
| | - Yoshio Misawa
- Division of Cardiovascular Surgery Jichi Medical University Shimotsuke Japan
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15
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Morishita A, Tomioka H, Katahira S, Hoshino T, Hanzawa K. Delayed visceral and spinal cord malperfusion after axillo-bifemoral bypass for complicated acute type B aortic dissection. Ann Vasc Dis 2014; 7:331-4. [PMID: 25298840 DOI: 10.3400/avd.cr.14-00059] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2014] [Accepted: 06/11/2014] [Indexed: 11/13/2022] Open
Abstract
We describe a successfully treated case of acute type B aortic dissection complicated with lower extremity, visceral, and spinal cord malperfusion. To restore perfusion to both lower extremities, we performed an emergency right axillo-bifemoral bypass. Furthermore, we performed total arch replacement, including primary entry closure, because of delayed visceral organ ischemia. Unexpectedly, delayed paraplegia occurred after hospital discharge; however, the patient recovered without any neurologic sequelae after early introduction of hyperbaric oxygen therapy. Because another episode of organ malperfusion in the long term cannot be anticipated, and even though the previous organ malperfusion episode was treated successfully, close observation is mandatory for detecting clinical manifestations in combination with the availability of imaging modalities.
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Affiliation(s)
- Atsushi Morishita
- Department of Cardiovascular Surgery, Numata Neurosurgery Heart-Disease Hospital, Numata, Gunma, Japan
| | - Hideyuki Tomioka
- Department of Cardiovascular Surgery, Heart Institute of Japan, Tokyo Women's, Medical University, Tokyo, Japan
| | | | - Takeshi Hoshino
- Department of Anesthesiology, Minami Machida Hospital, Machida, Tokyo, Japan
| | - Kazuhiko Hanzawa
- Department of Thoracic and Cardiovascular Surgery, Niigata University School of Medicine, Niigata, Niigata, Japan
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16
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Moulakakis KG, Mylonas SN, Dalainas I, Kakisis J, Kotsis T, Liapis CD. Management of complicated and uncomplicated acute type B dissection. A systematic review and meta-analysis. Ann Cardiothorac Surg 2014; 3:234-46. [PMID: 24967162 DOI: 10.3978/j.issn.2225-319x.2014.05.08] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2014] [Accepted: 05/21/2014] [Indexed: 01/25/2023]
Abstract
BACKGROUND The management of acute type B dissection represents a clinical challenge. We undertook a systematic review of the available literature regarding medical, surgical and endovascular treatments of acute type B aortic dissection and combined the eligible studies into a meta-analysis. METHODS An extensive electronic health database search was performed on all articles published from January 2006 up to November 2013 describing the management of acute type B aortic dissection. Studies including less than 15 patients were excluded. RESULTS ACUTE COMPLICATED TYPE B DISSECTION: overall, 2,531 patients were treated with endovascular repair (TEVAR) and the pooled rate for 30-day/in-hospital mortality was 7.3%. The pooled estimates for cerebrovascular events, spinal cord ischemia (SCI) and total neurologic events were 3.9%, 3.1% and 7.3%, respectively. A total of 1,276 patients underwent open surgical repair and the pooled rate for 30-day/in-hospital mortality was 19.0%. The pooled rate for cerebrovascular events was 6.8%, for SCI 3.3% and for total neurologic complications 9.8%. Acute uncomplicated type B dissection: outcome of 2,347 patients who underwent conservative medical management were analyzed. The pooled 30-day/in-hospital mortality rate was 2.4%. The pooled rate for cerebrovascular events was 1%, for SCI 0.8% and for overall neurologic complications 2%. CONCLUSIONS Endovascular repair provides a superior 30-day/in-hospital survival for acute complicated type B aortic dissection compared to surgical aortic reconstruction. However, open repair still has a significant role as endovascular repair is not applicable in all patients and there remains concerns regarding the durability of this technique. TEVAR seems to have a more favorable outcome regarding aortic remodeling and the aortic-specific survival rate when compared with medical therapy alone. Randomized controlled trials focusing on the prognostic factors of early and late complications in uncomplicated type B dissections are needed.
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Affiliation(s)
- Konstantinos G Moulakakis
- 1 Department of Vascular Surgery, Athens University Medical School, Attikon University Hospital, Athens, Greece ; 2 The Collaborative Research Group, Macquarie University, Sydney, Australia ; 3 Vascular Unit, 2nd Clinic of Surgery, Aretaieion Hospital, Medical School, University of Athens, Athens, Greece
| | - Spyridon N Mylonas
- 1 Department of Vascular Surgery, Athens University Medical School, Attikon University Hospital, Athens, Greece ; 2 The Collaborative Research Group, Macquarie University, Sydney, Australia ; 3 Vascular Unit, 2nd Clinic of Surgery, Aretaieion Hospital, Medical School, University of Athens, Athens, Greece
| | - Ilias Dalainas
- 1 Department of Vascular Surgery, Athens University Medical School, Attikon University Hospital, Athens, Greece ; 2 The Collaborative Research Group, Macquarie University, Sydney, Australia ; 3 Vascular Unit, 2nd Clinic of Surgery, Aretaieion Hospital, Medical School, University of Athens, Athens, Greece
| | - John Kakisis
- 1 Department of Vascular Surgery, Athens University Medical School, Attikon University Hospital, Athens, Greece ; 2 The Collaborative Research Group, Macquarie University, Sydney, Australia ; 3 Vascular Unit, 2nd Clinic of Surgery, Aretaieion Hospital, Medical School, University of Athens, Athens, Greece
| | - Thomas Kotsis
- 1 Department of Vascular Surgery, Athens University Medical School, Attikon University Hospital, Athens, Greece ; 2 The Collaborative Research Group, Macquarie University, Sydney, Australia ; 3 Vascular Unit, 2nd Clinic of Surgery, Aretaieion Hospital, Medical School, University of Athens, Athens, Greece
| | - Christos D Liapis
- 1 Department of Vascular Surgery, Athens University Medical School, Attikon University Hospital, Athens, Greece ; 2 The Collaborative Research Group, Macquarie University, Sydney, Australia ; 3 Vascular Unit, 2nd Clinic of Surgery, Aretaieion Hospital, Medical School, University of Athens, Athens, Greece
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17
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Brunkwall J, Kasprzak P, Verhoeven E, Heijmen R, Taylor P, Alric P, Canaud L, Janotta M, Raithel D, Malina W, Resch T, Eckstein HH, Ockert S, Larzon T, Carlsson F, Schumacher H, Classen S, Schaub P, Lammer J, Lönn L, Clough RE, Rampoldi V, Trimarchi S, Fabiani JN, Böckler D, Kotelis D, Böckler D, Kotelis D, von Tenng-Kobligk H, Mangialardi N, Ronchey S, Dialetto G, Matoussevitch V. Endovascular repair of acute uncomplicated aortic type B dissection promotes aortic remodelling: 1 year results of the ADSORB trial. Eur J Vasc Endovasc Surg 2014; 48:285-91. [PMID: 24962744 DOI: 10.1016/j.ejvs.2014.05.012] [Citation(s) in RCA: 255] [Impact Index Per Article: 25.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2013] [Accepted: 05/12/2014] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Uncomplicated acute type B aortic dissection (AD) treated conservatively has a 10% 30-day mortality and up to 25% need intervention within 4 years. In complicated AD, stent grafts have been encouraging. The aim of the present prospective randomised trial was to compare best medical treatment (BMT) with BMT and Gore TAG stent graft in patients with uncomplicated AD. The primary endpoint was a combination of incomplete/no false lumen thrombosis, aortic dilatation, or aortic rupture at 1 year. METHODS The AD history had to be less than 14 days, and exclusion criteria were rupture, impending rupture, malperfusion. Of the 61 patients randomised, 80% were DeBakey type IIIB. RESULTS Thirty-one patients were randomised to the BMT group and 30 to the BMT+TAG group. Mean age was 63 years for both groups. The left subclavian artery was completely covered in 47% and in part in 17% of the cases. During the first 30 days, no deaths occurred in either group, but there were three crossovers from the BMT to the BMT+TAG group, all due to progression of disease within 1 week. There were two withdrawals from the BMT+TAG group. At the 1-year follow up there had been another two failures in the BMT group: one malperfusion and one aneurysm formation (p = .056 for all). One death occurred in the BMT+TAG group. For the overall endpoint BMT+TAG was significantly different from BMT only (p < .001). Incomplete false lumen thrombosis, was found in 13 (43%) of the TAG+BMT group and 30 (97%) of the BMT group (p < .001). The false lumen reduced in size in the BMT+TAG group (p < .001) whereas in the BMT group it increased. The true lumen increased in the BMT+TAG (p < .001) whereas in the BMT group it remained unchanged. The overall transverse diameter was the same at the beginning and after 1 year in the BMT group (42.1 mm), but in the BMT+TAG it decreased (38.8 mm; p = .062). CONCLUSIONS Uncomplicated AD can be safely treated with the Gore TAG device. Remodelling with thrombosis of the false lumen and reduction of its diameter is induced by the stent graft, but long term results are needed.
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Affiliation(s)
- J Brunkwall
- Department of Vascular and Endovascular Surgery, University Clinics, University of Cologne, Cologne, Germany.
| | - P Kasprzak
- Section of Vascular Surgery, Department of Surgery, University of Regensburg, Department of Vascular Surgery, Klinikum Nuernberg, Nuremberg, Germany
| | - E Verhoeven
- Department of Cardiovasc Surgery Antonius Hospital, Nieuwegein, The Netherlands
| | - R Heijmen
- Department of Vascular Surgery, St Guys Hospital, London, UK
| | - P Taylor
- Department of Vascular Surgery, St Guys Hospital, London, UK
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18
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Cheng Z, Zhao S, Wang X. Acute Retrograde Ascending Aortic Dissection During Thoracic Endovascular Aortic Repair in a Rare Triple-Barreled Aortic Dissection. Circ J 2014; 78:2328-9. [DOI: 10.1253/circj.cj-14-0304] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Zhaoping Cheng
- Department of Radiology, Shandong Medical Imaging Research Institute, Shandong University
| | - Shihua Zhao
- Department of Radiology, Fu Wai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College
| | - Ximing Wang
- Department of Radiology, Shandong Medical Imaging Research Institute, Shandong University
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19
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Kurabayashi M, Okishige K, Ueshima D, Yoshimura K, Shimura T, Suzuki H, Mitsutoshi A, Aoyagi H, Otani Y, Isobe M. Diagnostic Utility of Unenhanced Computed Tomography for Acute Aortic Syndrome. Circ J 2014; 78:1928-34. [DOI: 10.1253/circj.cj-14-0198] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
| | - Kaoru Okishige
- Division of Cardiology, Yokohama City Minato Red Cross Hospital
| | - Daisuke Ueshima
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University
| | | | - Tsukasa Shimura
- Division of Cardiology, Yokohama City Minato Red Cross Hospital
| | | | | | - Hideshi Aoyagi
- Division of Cardiology, Yokohama City Minato Red Cross Hospital
| | - Yoichi Otani
- Division of Radiology, Yokohama City Minato Red Cross Hospital
| | - Mitsuaki Isobe
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University
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20
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Fattori R, Cao P, De Rango P, Czerny M, Evangelista A, Nienaber C, Rousseau H, Schepens M. Interdisciplinary Expert Consensus Document on Management of Type B Aortic Dissection. J Am Coll Cardiol 2013; 61:1661-78. [PMID: 23500232 DOI: 10.1016/j.jacc.2012.11.072] [Citation(s) in RCA: 316] [Impact Index Per Article: 28.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2012] [Revised: 10/30/2012] [Accepted: 11/08/2012] [Indexed: 11/15/2022]
Affiliation(s)
- Rossella Fattori
- Department of Interventional Cardiology, San Salvatore Hospital, Pesaro, Italy.
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21
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Axillofemoral Bypass Relieves Visceral Malperfusion in Type B Aortic Dissection. Ann Thorac Surg 2013; 95:703-5. [DOI: 10.1016/j.athoracsur.2012.06.056] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2012] [Revised: 06/11/2012] [Accepted: 06/27/2012] [Indexed: 11/22/2022]
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