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Higuchi A, Kubota Y, Yokota H, Miyazaki H, Ota J, Okafuji Y, Takaoka H, Uno T. Computed tomography angiography assessment of Adamkiewicz artery with sublingual nitroglycerin administration. Neuroradiology 2024:10.1007/s00234-024-03433-9. [PMID: 39102086 DOI: 10.1007/s00234-024-03433-9] [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: 03/19/2024] [Accepted: 07/11/2024] [Indexed: 08/06/2024]
Abstract
PURPOSE Identification of the Adamkiewicz artery before aortic surgery is important for preventing postoperative complications due to spinal cord ischemia. The Adamkiewicz artery is difficult to identify due to its small diameter. Nitroglycerin has a vasodilatory effect and is used clinically to improve visualization of blood vessels on coronary computed tomography (CT) angiography. We investigated whether the vasodilatory effect of nitroglycerin could improve the ability to visualize the Adamkiewicz artery. METHODS We extracted 33 cases wherein contrast-enhanced CT images were taken before and after aortic aneurysm surgery. Nitroglycerin was administered for coronary artery evaluation on the preoperative CT. However, no nitroglycerin was administered before the postoperative CT. Aortic contrast-to-noise ratio, CT value, image noise, and diameter of the Adamkiewicz artery and anterior spinal artery were measured. The depiction of the Adamkiewicz artery was graded into four grades and evaluated. These measurements were performed by two independent reviewers. RESULTS In nitroglycerin-administered cases, the contrast-to-noise ratio and CT values were significantly higher (P < 0.001, P < 0.001, respectively); the Adamkiewicz artery and anterior spinal artery diameters were dilated (P = 0.005, P = 0.001, respectively). The Adamkiewicz artery score also improved significantly (P < 0.001). No significant difference was found in image noise. CONCLUSION Nitroglycerin contributed to improving the Adamkiewicz artery's visualization.
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Affiliation(s)
- Akio Higuchi
- Department of Radiology, Chiba University Hospital, Chiba, Japan
| | - Yoshihiro Kubota
- Department of Radiology, Chiba University Hospital, Chiba, Japan.
| | - Hajime Yokota
- Department of Diagnostic Radiology and Radiation Oncology, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Hiroki Miyazaki
- Department of Radiology, Chiba University Hospital, Chiba, Japan
| | - Joji Ota
- Department of Radiology, Chiba University Hospital, Chiba, Japan
| | - Yasuaki Okafuji
- Department of Radiology, Numazu City Hospital, Shizuoka, Japan
| | - Hiroyuki Takaoka
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Takashi Uno
- Department of Diagnostic Radiology and Radiation Oncology, Chiba University Graduate School of Medicine, Chiba, Japan
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Hari Y, Takagi H. Urgent Thoracic Endovascular Aortic Repair for Type-B 0,D Acute Aortic Dissection. Ann Vasc Surg 2024; 109:1-8. [PMID: 39025222 DOI: 10.1016/j.avsg.2024.05.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2024] [Revised: 05/27/2024] [Accepted: 05/31/2024] [Indexed: 07/20/2024]
Abstract
BACKGROUND The objective of the present study is to clarify safety and efficacy of thoracic endovascular aortic repair (TEVAR), excluding the primary entry in the descending aorta, for type-B0,D acute aortic dissection (TB0,DAAD) (so-called retrograde type-A acute aortic dissection). METHODS Forty-six patients with hyperacute-phase (within 2 days after the onset) type-A acute aortic dissection (TAAAD) and TB0,DAAD underwent urgent (on the admission or next day) intervention (TEVAR or conventional surgical aortic repair [CSAR]) for 2 years. Results of TEVAR for TB0,DAAD were compared with those of CSAR for TAAAD. Outcomes included 30-day mortality, aortic reintervention, and major complications (stroke and paraplegia/paraparesis). Details of TEVAR were also analyzed. RESULTS Seven patients with TB0,DAAD and 39 patients with TAAAD underwent respectively urgent TEVAR and CSAR. Aortic reintervention was significantly more frequent in the TEVAR than CSAR group (28.6% vs. 0%, P < 0.01). There was no difference in incidence of death and stroke between the TEVAR and CSAR group. All the 7 patients survived and 5 of the 7 (71.4%) patients were relieved of aortic reintervention for 30 days following TEVAR. One patient, however, underwent aortic arch replacement on postoperative day (POD) 1 owing to the patent and nonshrinking ascending false lumen (FL). The entry existed in the aortic arch. Another patient underwent ascending and transverse aortic replacement with frozen elephant trunk on POD13 due to proximal stent graft-induced new entry irrespective of the thrombosed and shrinking ascending FL. Because of the patent and nonshrinking ascending FL, 1 patient underwent additional TEVAR for the residual entry in the distal descending thoracic aorta on POD33 and subsequently ascending aortic replacement 4 months later. No entry was detected in the ascending or transverse aorta. The ascending FL in the other 4 patients was thrombosed early, shrinking gradually, and disappeared at last following TEVAR. CONCLUSIONS Urgent TEVAR for TB0,DAAD may be alternative to CSAR in selected cases. Accurate diagnosis of the primary entry location on preinterventional computed tomography scans for exclusion of the entry and cautious selection and delivery of a stent graft to prevent stent graft-induced new entry or endoleak are requisite for success of the procedure, remodeling of the FL, and satisfactory prognosis.
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Affiliation(s)
- Yosuke Hari
- Department of Cardiovascular Surgery, Shizuoka Medical Center, Shizuoka, Japan; Department of Cardiovascular Surgery, Kitasato University School of Medicine, Sagamihara, Japan
| | - Hisato Takagi
- Department of Cardiovascular Surgery, Shizuoka Medical Center, Shizuoka, Japan; Department of Cardiovascular Surgery, Kitasato University School of Medicine, Sagamihara, Japan.
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Akutsu K, Ozaki K, Oshima S, Sakurai S, Hirokami T, Hirai Y, Okiyama M, Kishinami G, Ishiko K, Yamaguchi K, Yamamoto S. Successful redo open thoracoabdominal aortic aneurysm surgery in a patient with vascular Ehlers-Danlos syndrome: A case report. J Cardiol Cases 2024; 30:16-19. [PMID: 39007042 PMCID: PMC11245757 DOI: 10.1016/j.jccase.2024.03.002] [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: 09/07/2023] [Revised: 01/16/2024] [Accepted: 03/05/2024] [Indexed: 07/16/2024] Open
Abstract
We report a case of a 63-year-old woman diagnosed with vascular Ehlers-Danlos syndrome (vEDS) who survived two prophylactic surgeries for the dilatation of a thoracoabdominal aortic aneurysm. She initially developed acute type B aortic dissection at the age of 44 years. Five years later, her dissected descending aorta was enlarged to 54 mm; thus, the descending aorta was replaced as the first surgery. Fortunately, the intra- and post-operative courses were uneventful. Fourteen years post her first surgery, the dissected thoracoabdominal aorta distal to the graft expanded to 53 mm; however, no anastomotic leakage was observed. Genetic testing revealed a COL3A1 abnormality, confirming the diagnosis of vEDS. Thoracoabdominal aorta replacement using deep hypothermia circulatory arrest was performed because of the high risk of aortic aneurysm rupture. The second surgery was performed without complications, and no complications were observed 13 months post-surgery. The major reason for a successful surgery in this patient was the relatively low vascular fragility associated with vEDS. This case demonstrates that there may be considerable individual differences in vascular fragility in patients with vEDS. Thus, surgical repair, along with endovascular therapy, might still be a beneficial option for patients with vEDS having large aortic aneurysms and a high risk of rupture. Learning objective Prophylactic surgery for vascular lesions in Ehlers-Danlos syndrome (vEDS) is generally not recommended because of its high vascular fragility. However, if a patient with vEDS has an aortic aneurysm that is at a very high risk of rupture, aggressive treatment is a plausible option as there may be considerable individual differences in vascular fragility among patients with vEDS.
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Affiliation(s)
- Koichi Akutsu
- Department of Aortic Surgery, Kawasaki Aortic Center, Kawasaki Saiwai Hospital, Kawasaki, Japan
- Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan
| | - Kensuke Ozaki
- Department of Aortic Surgery, Kawasaki Aortic Center, Kawasaki Saiwai Hospital, Kawasaki, Japan
| | - Susumu Oshima
- Department of Aortic Surgery, Kawasaki Aortic Center, Kawasaki Saiwai Hospital, Kawasaki, Japan
| | - Shigeru Sakurai
- Department of Aortic Surgery, Kawasaki Aortic Center, Kawasaki Saiwai Hospital, Kawasaki, Japan
| | - Tomohiro Hirokami
- Department of Aortic Surgery, Kawasaki Aortic Center, Kawasaki Saiwai Hospital, Kawasaki, Japan
| | - Yuki Hirai
- Department of Aortic Surgery, Kawasaki Aortic Center, Kawasaki Saiwai Hospital, Kawasaki, Japan
| | - Makoto Okiyama
- Department of Aortic Surgery, Kawasaki Aortic Center, Kawasaki Saiwai Hospital, Kawasaki, Japan
| | - Goro Kishinami
- Department of Aortic Surgery, Kawasaki Aortic Center, Kawasaki Saiwai Hospital, Kawasaki, Japan
| | - Kazumasa Ishiko
- Department of Aortic Surgery, Kawasaki Aortic Center, Kawasaki Saiwai Hospital, Kawasaki, Japan
| | - Ko Yamaguchi
- Department of Aortic Surgery, Kawasaki Aortic Center, Kawasaki Saiwai Hospital, Kawasaki, Japan
| | - Shin Yamamoto
- Department of Aortic Surgery, Kawasaki Aortic Center, Kawasaki Saiwai Hospital, Kawasaki, Japan
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Kawamoto T, Kogure T, Koyanagi C, Ashihara K, Yamaguchi J. Mitral valve transcatheter edge-to-edge repair as a bridge to treat aortic dissecting aneurysm in a case of Marfan syndrome: a case report. Eur Heart J Case Rep 2024; 8:ytae338. [PMID: 39045521 PMCID: PMC11263868 DOI: 10.1093/ehjcr/ytae338] [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: 02/06/2024] [Revised: 03/25/2024] [Accepted: 07/03/2024] [Indexed: 07/25/2024]
Abstract
Background Marfan syndrome is an inherited disorder that manifests with various cardiovascular conditions. This case report discusses a patient with Marfan syndrome presenting with concurrent dissecting aortic aneurysm and acute mitral valve regurgitation (MR), exploring treatment strategies for this unique case. Case summary A 57-year-old man diagnosed with Marfan syndrome presented with progressive dyspnoea and awareness of orthopnoea. Acute heart failure (HF) due to acute MR associated with chordae rupture was diagnosed. However, contrast-enhanced CT revealed the coexistence of a massive dissecting aortic aneurysm, indicating surgical intervention. The dissecting aortic aneurysm extended over a large area. Given the high risk of simultaneous surgery with the mitral valve, a staged approach was adopted. Mitral valve transcatheter edge-to-edge repair (MV-TEER) was performed as the initial step to reduce the perioperative HF risk, followed by a planned two-stage surgery for the dissecting aortic aneurysm. This strategy effectively facilitated surgical intervention for the dissecting aortic aneurysm in the chronic phase after MV-TEER. Discussion Several reports showed the effectiveness of MV-TEER in cases of degenerative MR where surgical operation carries a high risk, but case report of MV-TEER in Marfan syndrome is rare. In recent years, the effectiveness of MV-TEER has also been reported as a 'bridge therapy' for heart transplantation. Mitral valve transcatheter edge-to-edge repair is considered a potential option to serve as a bridge to other invasive intervention.
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Affiliation(s)
- Takanori Kawamoto
- Department of Cardiology, Tokyo Women’s Medical University, 162-8666, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, Japan
| | - Tomohito Kogure
- Department of Cardiology, Tokyo Women’s Medical University, 162-8666, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, Japan
| | - Chihiro Koyanagi
- Department of Cardiology, Tokyo Women’s Medical University, 162-8666, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, Japan
| | - Kyomi Ashihara
- Department of Cardiology, Tokyo Women’s Medical University, 162-8666, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, Japan
| | - Junichi Yamaguchi
- Department of Cardiology, Tokyo Women’s Medical University, 162-8666, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, Japan
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Saito T, Saito T, Ishii T, Homma K, Kunii Y, Koide M, Ohashi T. Acute Treatment of Ischemic Stroke Caused by Stent Graft Thrombosis After Thoracic Endovascular Aortic Repair. Cureus 2024; 16:e64465. [PMID: 39135813 PMCID: PMC11318640 DOI: 10.7759/cureus.64465] [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] [Accepted: 07/13/2024] [Indexed: 08/15/2024] Open
Abstract
Planning for the acute phase of ischemic stroke in postoperative patients with aortic dissection is difficult from the perspective of concerns about worsening disease related to aortic dissection due to intravenous thrombolytic agents and securing access routes when mechanical thrombectomy is planned. Herein, we report that a 52-year-old man underwent thoracic endovascular aortic repair for acute type B aortic dissection. One year after the procedure, the patient developed a stroke caused by stent graft thrombosis, and computed tomography angiography showed occlusion of the left common carotid artery and left internal carotid artery. Stroke neurologists performed mechanical thrombectomy via a direct approach from the left common carotid artery, and successful recanalization was achieved. Furthermore, ligation of the proximal portion of the left common carotid artery and bypass surgery on the distal portion of the left common carotid artery were performed by cardiovascular surgeons. Although the patient had a postoperative hemorrhagic infarction, he returned to work without a recurrence of stroke after two years of follow-up. A direct carotid artery puncture we performed is an alternative in cases of anatomical difficulty or an unfavorable aortic arch. This case highlights not only the significance of interdisciplinary collaboration between cardiac and neurological specialists but also the impact of training dual-specialty cerebrovascular neurosurgeons on patient outcomes.
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Affiliation(s)
- Takashi Saito
- Department of Neurology, Seirei Hamamatsu General Hospital, Hamamatsu City, JPN
| | - Takuya Saito
- Department of Neurology, Seirei Hamamatsu General Hospital, Hamamatsu City, JPN
| | - Tatsuhito Ishii
- Department of Neurology, Seirei Hamamatsu General Hospital, Hamamatsu City, JPN
| | - Kazunari Homma
- Department of Neurology, Seirei Hamamatsu General Hospital, Hamamatsu City, JPN
| | - Yoshifumi Kunii
- Department of Cardiovascular Surgery, Seirei Hamamatsu General Hospital, Hamamatsu City, JPN
| | - Masaaki Koide
- Department of Cardiovascular Surgery, Seirei Hamamatsu General Hospital, Hamamatsu City, JPN
| | - Toshihiko Ohashi
- Department of Neurology, Seirei Hamamatsu General Hospital, Hamamatsu City, JPN
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Kageyama S, Ohashi T, Kojima A, Kojima T. Emergency Open Surgical Repair for Ruptured Abdominal Aortic Aneurysm in Octogenarians and Nonagenarians: A Single-Center Retrospective Observational Study. Ann Vasc Surg 2024; 108:36-46. [PMID: 38942379 DOI: 10.1016/j.avsg.2024.04.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Revised: 03/14/2024] [Accepted: 04/07/2024] [Indexed: 06/30/2024]
Abstract
BACKGROUND In the endovascular aneurysm repair era, open surgical repair (OSR) is performed for ruptured abdominal aorta aneurysm (RAAA) in patients with complex aneurysm neck and technical difficulties. Understanding the risk factors of OSR is essential for the clinical selection of the ideal surgical procedure. We aimed to re-evaluate the outcomes of OSR and treatment options for RAAA. METHODS Patients who underwent OSR for RAAA between January 2010 and December 2022 were enrolled in this single-center retrospective observational study. Preoperative status, operative findings, and postoperative course were retrospectively reviewed. The Cox proportional hazards model was used to evaluate the association between age and early postoperative mortality. RESULTS Among 142 patients, 43 (30.3%) and 99 (69.7%) were aged ≥80 and <80 years, respectively. Postoperative mortality within 30 days occurred in 24 (16.9%) patients (11/43 [25.6%] and 13/99 [13.1%] patients aged ≥80 and <80 years, respectively; hazard ratio = 1.95; P = 0.069). In a multivariable analysis, increased postoperative mortality within 30 days was associated with age ≥80 years (adjusted hazard ratio, aHR = 2.36; P = 0.049), the presence of preoperative or intraoperative cardiopulmonary arrest (aHR = 12.0; P < 0.001), and postoperative gastrointestinal disorder (aHR = 4.42; P = 0.003). CONCLUSIONS Endovascular aneurysm repair may be preferable in older people; however, its use in cases of preoperative or intraoperative cardiopulmonary arrest or perioperative gastrointestinal disorders remains controversial, and a careful discussion on the surgical indications is needed in such cases.
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Affiliation(s)
- Soichiro Kageyama
- Department of Cardiovascular Surgery, Nagoya Tokushukai General Hospital, Kasugai-city, Aichi, Japan
| | - Takeki Ohashi
- Department of Cardiovascular Surgery, Nagoya Tokushukai General Hospital, Kasugai-city, Aichi, Japan
| | - Akinori Kojima
- Department of Cardiovascular Surgery, Nagoya Tokushukai General Hospital, Kasugai-city, Aichi, Japan
| | - Taiki Kojima
- Department of Anesthesiology, Aichi Children's Health and Medical Center, Obu-shi, Aichi, Japan; Division of Comprehensive Pediatric Medicine, Graduate School of Nagoya University, Showa-ku, Nagoya, Japan.
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Sugihara R, Kioka H, Sakata Y. Direct Oral Anticoagulant Treatment for Atherosclerosis-Induced Aortic Mural Thrombus in an Elderly Male With Aspirin Resistance. Cureus 2024; 16:e62691. [PMID: 39036112 PMCID: PMC11259519 DOI: 10.7759/cureus.62691] [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] [Accepted: 06/18/2024] [Indexed: 07/23/2024] Open
Abstract
Aortic mural thrombus is associated with atherosclerosis in a vast majority of cases and could result in multiple organ damage, leading to higher morbidity and mortality rates. Although aspirin could be effective for primary prevention in atherosclerosis-induced aortic mural thrombus, aspirin resistance, which refers to the inadequate response to aspirin therapy, allows the progression of thrombus. Classically, warfarin could be an effective treatment for thromboembolic diseases, while in recent years, direct oral anticoagulants (DOACs) have shown superior safety and efficacy, particularly in elderly patients. This report presents the case of an elderly male with chronic aortic mural thrombi due to atherosclerosis and aspirin resistance who achieved favorable outcomes following treatment with DOACs. DOACs could be a possible option for managing aortic mural thrombus with aspirin resistance.
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Affiliation(s)
- Ryuta Sugihara
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Osaka, JPN
| | - Hidetaka Kioka
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Osaka, JPN
| | - Yasushi Sakata
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Osaka, JPN
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He K, Qin X, Li M, Bian L, Yue H, Liang W, Wu Z. Two surgical strategies (early carotid reperfusion vs. Central aortic repair-first) of acute type a aortic dissection complicated with cerebral malperfusion syndrome: a meta-analysis and systematic review. BMC Cardiovasc Disord 2024; 24:239. [PMID: 38714966 PMCID: PMC11075335 DOI: 10.1186/s12872-024-03910-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Accepted: 04/30/2024] [Indexed: 05/12/2024] Open
Abstract
OBJECTIVE Cerebral malperfusion (CM) is a common comorbidity in acute type A aortic dissection (ATAAD), which is associated with high mortality and poor neurological prognosis. This meta-analysis investigated the surgical strategy of ATAAD patients with CM, aiming to compare the difference in therapeutic effectiveness between the central repair-first and the early reperfusion-first according to clinical outcomes. METHODS The meta-analysis and systematic review was conducted based on studies sourced from the PubMed, Embase, and Cochrane literature database, in which cases of ATAAD with CM underwent surgical repair were included. Data for baseline characteristics, mortality, survival were extracted, and risk ratio (RR) values and the pooled mortality were calculated. RESULTS A total of 17 retrospective studies were analyzed, including 1010 cases of ATAAD with CM underwent surgical repair. The pooled early mortality in early reperfusion group was lower (8.1%; CI, 0.02 to 0.168) than that in the central repair group (16.2%; CI, 0.115 to 0.216). The pooled long-term mortality was 7.9% in the early reperfusion cohort and 17.4% the central repair-first cohort, without a statistically significant heterogeneity (I [2] = 51.271%; p = 0.056). The mean time of symptom-onset-to-the-operation-room in all the reports was 8.87 ± 12.3 h. CONCLUSION This meta-analysis suggested that early reperfusion-first may achieved better outcomes compared to central repair-first in ATAAD patients complicated with CM to some extent. Early operation and early restoration of cerebral perfusion may reduce the occurrence of some neurological complications. TRIAL REGISTRATION The meta-analysis was registered in the International Prospective Register of Systematic Reviews database (No. CRD CRD42023475629) on Nov. 8th, 2023.
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Affiliation(s)
- Kang He
- Department of Cardiovascular surgery, West China Hospital of Sichuan University, Chengdu, Sichuan, 610041, China
| | - Xiaoli Qin
- Department of Cardiovascular surgery, West China Hospital of Sichuan University, Chengdu, Sichuan, 610041, China
| | - Mei Li
- Department of Cardiovascular surgery, West China Hospital of Sichuan University, Chengdu, Sichuan, 610041, China
| | - Longrong Bian
- Department of Cardiovascular surgery, West China Hospital of Sichuan University, Chengdu, Sichuan, 610041, China
| | - Honghua Yue
- Department of Cardiovascular surgery, West China Hospital of Sichuan University, Chengdu, Sichuan, 610041, China
| | - Weitao Liang
- Department of Cardiovascular surgery, West China Hospital of Sichuan University, Chengdu, Sichuan, 610041, China
| | - Zhong Wu
- Department of Cardiovascular surgery, West China Hospital of Sichuan University, Chengdu, Sichuan, 610041, China.
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Fujimura N, Ichihashi S, Shibata T, Matsumura H, Watanabe M, Morikage N, Kurimoto Y, Banno H, Uchiyama H, Obara H. Early Clinical Results From the Japanese Prospective Multicenter Study to Evaluate Zenith Alpha Abdominal Stent Graft for Abdominal Aortic Aneurysm (JUSTICE) Registry Demonstrate Acceptable Limb Patency at 12 Months. J Endovasc Ther 2024:15266028241248311. [PMID: 38654524 DOI: 10.1177/15266028241248311] [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: 04/26/2024]
Abstract
PURPOSE Recent reports of the Zenith Alpha abdominal endovascular graft (Zenith Alpha AAA, Cook, Inc., Bloomington, Indiana) have demonstrated an unexpectedly high incidence of limb graft occlusion (LGO). The purpose of this study was to prospectively evaluate the performance of the Zenith AAA in Japan, with a specific focus on LGO. MATERIALS AND METHODS All endovascular aneurysm repairs (EVARs) for abdominal aortic aneurysms performed using the Zenith Alpha AAA from July 2020 to October 2021 in 23 Japanese hospitals were prospectively evaluated. All computed tomographic images were analyzed in the core laboratory. Late complications were defined as any aneurysm-related events occurring >30 days after EVAR, including aneurysm sac enlargement of >5 mm and any reinterventions performed. Endoleaks without sac enlargement or reintervention were excluded as late complications. RESULTS During the study period, 147 EVARs were performed using the Zenith Alpha AAA. The mean patient age was 76.5±7.7 years, 84.4% of patients were male, and the mean aneurysm diameter was 52.4±9.2 mm. Instruction-for-use violations were observed in 76 patients (51.7%), primarily associated with a severely angulated proximal neck (>60°). There were six intraoperative complications and 62 additional intraoperative treatments reported, most of which involved preemptive coil embolization of the inferior mesenteric artery (37 cases). Technical success, defined as the absence of type 1 or 3 endoleaks on final angiography, was achieved in 99.3% of patients. At 12 months, there was only one case of type 1/3 endoleak (0.8%) and one aneurysm sac enlargement exceeding 5 mm (0.8%); however, a high incidence of type 2 endoleaks was observed in 35.2% of patients, and aneurysm sac regression exceeding 5 mm was achieved in 30.1% of patients. Nine late complications were observed, and the rate of freedom from late complications at 12 months was 93.5%, encompassing four LGOs and one limb graft stenosis (3.4%). CONCLUSIONS In contrast to recent reports, our Japanese multicenter prospective study demonstrated satisfactory early clinical results, including an acceptable LGO rate, for the low-profile Zenith Alpha AAA. Long-term follow-ups will be performed to confirm the persistence of these outcomes. CLINICAL IMPACT This study prospectively evaluated the performance of 147 Zenith Alpha AAAs used for endovascular aneurysm repair with core-lab adjudication focusing especially on limb graft occlusion (LGO). At 12 months, aneurysm sac regression exceeding 5 mm was achieved in 30.1% of patients, and there was only one type 1/3 endoleak, one aneurysm sac enlargement (>5 mm), and nine late complications including five LGOs (3.4%), resulting in rate of freedom from late complications at 93.5%. Satisfactory early clinical results, including an acceptable rate of LGO can be achieved, particularly with cautious usage of the Zenith Alpha Spiral-Z Endovascular Leg." 5mm), and nine late complications including five LGOs (3.4%), resulting in rate of freedom from late complications at 93.5%. Satisfactory early clinical results, including an acceptable rate of LGO can be achieved, particularly with cautious usage of the Zenith Alpha Spiral-Z Endovascular Leg.
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Affiliation(s)
- Naoki Fujimura
- Department of Vascular Surgery, Tokyo Saiseikai Central Hospital, Tokyo, Japan
| | | | - Tsuyoshi Shibata
- Department of Cardiovascular Surgery, Sapporo Medical University, Hokkaido, Japan
| | - Hitoshi Matsumura
- Department of Cardiovascular Surgery, School of Medicine, Fukuoka University, Fukuoka, Japan
| | - Michiko Watanabe
- Department of Cardiovascular Surgery, Chiba University, Chiba, Japan
| | - Noriyasu Morikage
- Department of Vascular Surgery, Yamaguchi University, Yamaguchi, Japan
| | - Yoshihiko Kurimoto
- Department of Cardiovascular Surgery, Teine Keijinkai Hospital, Hokkaido, Japan
| | - Hiroshi Banno
- Division of Vascular and Endovascular Surgery, Department of Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Hidetoshi Uchiyama
- Department of Vascular Surgery, Tsuchiura Kyodo General Hospital, Ibaraki, Japan
| | - Hideaki Obara
- Department of Surgery, Keio University School of Medicine, Tokyo, Japan
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Wyss TR, Giardini M, Sörelius K. Infective Native Aortic Aneurysm: a Delphi Consensus Document on Treatment, Follow Up, and Definition of Cure. Eur J Vasc Endovasc Surg 2024; 67:654-661. [PMID: 38097164 DOI: 10.1016/j.ejvs.2023.12.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 11/23/2023] [Accepted: 12/10/2023] [Indexed: 02/12/2024]
Abstract
OBJECTIVE Evidence is lacking to guide the management of infective native aortic aneurysm (INAA). The aim of this study was to establish expert consensus on surgical and antimicrobial treatment and follow up, and to define when an INAA is considered cured. METHODS Delphi methodology was used. The principal investigators invited 47 international experts (specialists in infectious diseases, radiology, nuclear medicine, and vascular and cardiothoracic surgery) via email. Four Delphi rounds were performed, three weeks each, using an online questionnaire with initially 28 statements. The panellists rated the statements on a five point Likert scale. Comments on statements were analysed, statements were revised and added or deleted, and the results were presented in the iterative rounds. Consensus was defined as ≥ 75% of the panel rating a statement as strongly agree or agree on the Likert scale, and consensus on the final assessment was defined as Cronbach's alpha > 0.80. RESULTS All 49 panellists completed all four rounds, resulting in 100% participation. One statement was added based on the results and comments of the panel, resulting in 29 final statements: three on need for consensus, 20 on treatment, five on follow up, and one on definition of cure. All 29 statements reached agreement of ≥ 86%. Cronbach's alpha increased for each consecutive round; round 1, 0.85; round 2, 0.90; round 3, 0.91; and round 4, 0.94. Thus, consensus was reached for all statements. CONCLUSION INAAs are rare, and high level evidence to guide optimal management is lacking. This consensus document was established with the aim of helping clinicians manage these challenging patients, as a supplement to current guidelines. The presented consensus will need future amendments in accordance with newly acquired knowledge.
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Affiliation(s)
- Thomas R Wyss
- Department of Vascular Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland; Department of Interventional Radiology and Vascular Surgery, Kantonsspital Winterthur, Winterthur, Switzerland.
| | - Matteo Giardini
- Department of Vascular Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland; Department of Interventional Radiology and Vascular Surgery, Kantonsspital Winterthur, Winterthur, Switzerland
| | - Karl Sörelius
- Department of Vascular Surgery, Rigshospitalet, University of Copenhagen, Copenhagen, and Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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Sakakibara K, Nakajima H, Hagihara Y, Nakamura C, Shikata D, Takesue Y, Shiraiwa S, Honda Y, Kaga S, Hamasaki M, Johno H. Evaluation of flow dynamics in distal stent graft-induced new entry using 4D flow MRI. Clin Case Rep 2024; 12:e8739. [PMID: 38585588 PMCID: PMC10995266 DOI: 10.1002/ccr3.8739] [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: 12/17/2023] [Revised: 02/13/2024] [Accepted: 02/28/2024] [Indexed: 04/09/2024] Open
Abstract
Distal stent graft-induced new entry may occur after stent grafting for aortic dissection. Four-dimensional magnetic resonance imaging is useful for predicting outcomes, showing accelerated flow and increased wall shear stress, indicating further false lumen expansion.
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Affiliation(s)
- Kenji Sakakibara
- Department of Surgery (II), Faculty of MedicineUniversity of YamanashiChuo CityJapan
| | - Hiroyuki Nakajima
- Department of Surgery (II), Faculty of MedicineUniversity of YamanashiChuo CityJapan
| | - Yudai Hagihara
- Department of Surgery (II), Faculty of MedicineUniversity of YamanashiChuo CityJapan
| | - Chie Nakamura
- Department of Surgery (II), Faculty of MedicineUniversity of YamanashiChuo CityJapan
| | - Daichi Shikata
- Department of Surgery (II), Faculty of MedicineUniversity of YamanashiChuo CityJapan
| | - Yuki Takesue
- Department of Surgery (II), Faculty of MedicineUniversity of YamanashiChuo CityJapan
| | - Satoru Shiraiwa
- Department of Surgery (II), Faculty of MedicineUniversity of YamanashiChuo CityJapan
| | - Yoshihiro Honda
- Department of Surgery (II), Faculty of MedicineUniversity of YamanashiChuo CityJapan
| | - Shigeaki Kaga
- Department of Surgery (II), Faculty of MedicineUniversity of YamanashiChuo CityJapan
| | - Masahiro Hamasaki
- Department of Radiology, Faculty of MedicineUniversity of YamanashiChuo CityJapan
| | - Hisashi Johno
- Department of Radiology, Faculty of MedicineUniversity of YamanashiChuo CityJapan
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12
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Yoshifuji H, Nakaoka Y, Uchida HA, Sugihara T, Watanabe Y, Funakoshi S, Isobe M, Harigai M. Organ Damage and Quality of Life in Takayasu Arteritis - Evidence From a National Registry Analysis. Circ J 2024; 88:285-294. [PMID: 38123296 DOI: 10.1253/circj.cj-23-0656] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2023]
Abstract
BACKGROUND Takayasu arteritis, affecting primarily young women, damages large arteries and organs. We examined the impact of disease duration and sex on organ damage and quality of life using Japan's Intractable Disease Registry. METHODS AND RESULTS After refining data, 2,013 of 2,795 patients were included in the study. Longer disease duration was related to a lower prevalence of disease activity symptoms, a higher prevalence of organ damage, and a higher proportion of patients requiring nursing care. Compared with men, women tended to have an earlier onset age, exhibiting longer disease duration. A higher proportion of women had aortic regurgitation and required nursing care. The proportion of female patients in employment was lower than that of the general female population, whereas no difference was observed between male patients and the general male population. Logistic regression analysis revealed that age at surveillance, brain ischemia, visual impairment/loss, and ischemic heart disease were significant factors associated with high nursing care needs (Level ≥2, with daily activity limitations). CONCLUSIONS Early diagnosis and effective treatment, particularly to prevent brain ischemia, visual impairment, and ischemic heart disease, may improve the quality of life of patients with Takayasu arteritis, especially women.
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Affiliation(s)
- Hajime Yoshifuji
- Department of Rheumatology and Clinical Immunology, Graduate School of Medicine, Kyoto University
| | - Yoshikazu Nakaoka
- Department of Vascular Physiology, National Cerebral and Cardiovascular Center Research Institute
| | - Haruhito A Uchida
- Department of Chronic Kidney Disease and Cardiovascular Disease, Okayama University Faculty of Medicine, Dentistry and Pharmaceutical Sciences
| | - Takahiko Sugihara
- Division of Rheumatology, Department of Internal Medicine, Toho University School of Medicine
| | | | - Sohei Funakoshi
- Department of Rheumatology and Clinical Immunology, Graduate School of Medicine, Kyoto University
| | | | - Masayoshi Harigai
- Division of Rheumatology, Department of Internal Medicine, Tokyo Women's Medical University School of Medicine
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13
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Furui M, Uesugi N, Matsumura H, Hayashida Y, Kuwahara G, Fujii M, Shimizu M, Morita Y, Ito C, Hayama M, Wada H. Relationship between false lumen morphology and entry tear in acute type A aortic dissection. Eur J Cardiothorac Surg 2024; 65:ezad389. [PMID: 37988138 DOI: 10.1093/ejcts/ezad389] [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: 08/13/2023] [Revised: 11/14/2023] [Accepted: 11/20/2023] [Indexed: 11/22/2023] Open
Abstract
OBJECTIVES This study aimed to investigate the relationship between false lumen morphology and the size, aortic segment and position of the entry tear for acute type A aortic dissection. METHODS The records of patients who underwent emergency operation for acute type A aortic dissection in our institution between April 2011 and May 2022 were examined. Data regarding size, location and position of the entry tear and preoperative computed tomography findings were reviewed. The relationship of these variables with false lumen morphology was examined and retrospectively compared according to tear size. RESULTS Of 243 cases, characteristics of the entry tear, visualized during surgery, were confirmed in 134 cases (age = 70.9 ± 12.6 years, male = 45.5%). Tear sizes at different aortic segments were not significantly different (P = 0.376). Tears posterior to the lesser curvature were significantly smaller than those anterior to the greater curvature (P = 0.004). A thrombosed false lumen was associated with a significantly smaller tear size and position on the posterior to the lesser curvature side in aortic cross-section (all P < 0.001). Multivariate analysis showed that tear size, the presence of re-entry and tear position anterior to the greater curvature were independent predictors of a patent false lumen. CONCLUSIONS In acute type A aortic dissection, larger tear size, the presence of re-entry and tear position anterior to the greater curvature are risk factors for a patent false lumen. Although the results of this study are valid only for patients in whom intimal tears were detected during aortic surgery, this trend may provide information for pathophysiology of the disease.
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Affiliation(s)
- Masato Furui
- Cardiovascular Surgery Department, Fukuoka University Hospital, Fukuoka, Japan
| | - Noriko Uesugi
- Pathology Department, Fukuoka University Hospital, Fukuoka, Japan
| | - Hitoshi Matsumura
- Cardiovascular Surgery Department, Fukuoka University Hospital, Fukuoka, Japan
| | - Yoshio Hayashida
- Cardiovascular Surgery Department, Fukuoka University Hospital, Fukuoka, Japan
| | - Go Kuwahara
- Cardiovascular Surgery Department, Fukuoka University Hospital, Fukuoka, Japan
| | - Mitsuru Fujii
- Cardiovascular Surgery Department, Fukuoka University Hospital, Fukuoka, Japan
| | - Masayuki Shimizu
- Cardiovascular Surgery Department, Fukuoka University Hospital, Fukuoka, Japan
| | - Yuichi Morita
- Cardiovascular Surgery Department, Fukuoka University Hospital, Fukuoka, Japan
| | - Chihaya Ito
- Cardiovascular Surgery Department, Fukuoka University Hospital, Fukuoka, Japan
| | - Masato Hayama
- Cardiovascular Surgery Department, Fukuoka University Hospital, Fukuoka, Japan
| | - Hideichi Wada
- Cardiovascular Surgery Department, Fukuoka University Hospital, Fukuoka, Japan
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14
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Kitamura T, Shikata F, Torii S, Mishima T, Fukuzumi M, Motoji Y, Tamura Y, Kaneda S, Ishiwaki D, Miyaji K. Initial thickness of the crescent may not be a reliable predictor of complications in type A intramural haematoma. Eur J Cardiothorac Surg 2024; 65:ezae006. [PMID: 38212990 DOI: 10.1093/ejcts/ezae006] [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: 09/30/2023] [Revised: 12/11/2023] [Accepted: 01/09/2024] [Indexed: 01/13/2024] Open
Abstract
OBJECTIVES This study aimed to investigate changes in haematoma thickness during the early period and their association with disease progression in patients who received initial medical treatment for type A intramural haematoma (IMH). METHODS Medical records and serial computed tomography angiography (CTA) images of patients who did not undergo emergency aortic repair for type A IMH upon presentation were retrospectively reviewed. The haematoma remodelling rate was determined using the following equation: thickness of the haematoma on the first CTA (mm) - thickness of the haematoma on the second CTA (mm)time between the first and second CTAs (h). RESULTS Among the 40 patients included in this study, 38 were indicated for initial watch-and-wait strategy, whereas 2 were indicated for emergency aortic repair but declined it. During hospitalization, 10 patients developed disease progression, with 2 in-hospital mortality cases. Analysis of the haematoma remodelling rate in 39 patients revealed that such a rate was significantly associated with the reciprocal of the time from onset. Analysis of all 70 CTA examinations performed within 24 h after the onset of IMH showed that haematoma thickness was significantly associated with the logarithm of the time from onset. Initial regression of the haematoma was not necessarily associated with avoidance of disease progression. CONCLUSIONS In type A IMH, the thickness of the haematoma in the ascending aorta tended to decrease in the very early period; however, prompt regression of the haematoma was not necessarily associated with avoidance of disease progression.
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Affiliation(s)
- Tadashi Kitamura
- Department of Cardiovascular Surgery, Kitasato University School of Medicine, Kanagawa, Japan
| | - Fumiaki Shikata
- Department of Cardiovascular Surgery, Kitasato University School of Medicine, Kanagawa, Japan
| | - Shinzo Torii
- Department of Cardiovascular Surgery, Kitasato University School of Medicine, Kanagawa, Japan
| | - Toshiaki Mishima
- Department of Cardiovascular Surgery, Kitasato University School of Medicine, Kanagawa, Japan
| | - Masaomi Fukuzumi
- Department of Cardiovascular Surgery, Kitasato University School of Medicine, Kanagawa, Japan
| | - Yusuke Motoji
- Department of Cardiovascular Surgery, Kitasato University School of Medicine, Kanagawa, Japan
| | - Yoshimi Tamura
- Department of Cardiovascular Surgery, Kitasato University School of Medicine, Kanagawa, Japan
| | - Sakura Kaneda
- Department of Cardiovascular Surgery, Kitasato University School of Medicine, Kanagawa, Japan
| | - Daiki Ishiwaki
- Department of Cardiovascular Surgery, Kitasato University School of Medicine, Kanagawa, Japan
| | - Kagami Miyaji
- Department of Cardiovascular Surgery, Kitasato University School of Medicine, Kanagawa, Japan
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