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Naito N, Takagi H. Optimal Timing of Pre-emptive Thoracic Endovascular Aortic Repair in Uncomplicated Type B Aortic Dissection: A Network Meta-Analysis. J Endovasc Ther 2024:15266028241245282. [PMID: 38590280 DOI: 10.1177/15266028241245282] [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: 04/10/2024]
Abstract
BACKGROUND This network meta-analysis compares outcomes of optimal medical therapy (OMT) and pre-emptive thoracic endovascular aortic repair (TEVAR) for uncomplicated type B aortic dissection at different phases of chronicity. METHODS MEDLINE and EMBASE were searched through November 2023. Pooled short-term outcomes (short-term mortality, perioperative complications) and long-term outcomes (all-cause mortality, aortic-related mortality, aortic re-intervention rates) were calculated. RESULTS Systematic review identified 17 studies (2 randomized controlled trials, 3 propensity score matching, and 2 inverse probability weighting). Subacute-phase intervention had lower short-term mortality than the acute-phase (hazard ratio [HR] [95% confidence interval [CI]]=0.60 [0.38-0.94], p=0.027). No significant differences were observed in aortic rupture and paraplegia. Acute-phase TEVAR had a higher stroke incidence than subacute-phase intervention (HR [95% CI]=2.63 [1.36-5.09], p=0.042), chronic (HR [95% CI]=2.5 [1.03-6.2], p=0.043), and OMT (HR [95% CI]=1.57 [1.12-2.18], p=0.008). Acute-phase TEVAR had higher long-term all-cause mortality than subacute-phase intervention (HR [95% CI]=1.34 [1.03-1.74], p=0.03). Optimal medical therapy had elevated long-term all-cause mortality compared with subacute-phase TEVAR (HR [95% CI]=1.67 [1.25-2.33], p<0.001) and increased long-term aortic-related mortality vs acute-phase (HR [95% CI]=2.08 [1.31-3.31], p=0.002) and subacute-phase (HR [95% CI]=2.6 [1.62-4.18], p<0.01) interventions. No significant differences were observed in aortic re-intervention rates. CONCLUSIONS Pre-emptive TEVAR may offer lower all-cause mortality and aortic-related mortality than OMT. Considering lower short-term mortality, perioperative stroke rate, and long-term mortality, our findings support pre-emptive TEVAR during the subacute phase. CLINICAL IMPACT The optimal timing of pre-emptive thoracic endovascular aortic repair (TEVAR) for uncomplicated type B aortic dissection remains uncertain. This network meta-analysis suggests that the subacute phase (14-90 days from symptom onset) emerges as the optimal timing for pre-emptive TEVAR. This window is associated with lower rates of short-term complications and higher long-term survival rates compared with alternative strategies.
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Affiliation(s)
- Noritsugu Naito
- Department of Cardiovascular Surgery, Shizuoka Medical Center, Shizuoka, Japan
| | - Hisato Takagi
- Department of Cardiovascular Surgery, Shizuoka Medical Center, Shizuoka, Japan
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Kayali F, Jubouri M, Tan SZ, Mohammed I, Bashir M. Aortic remodeling in aortic dissection after frozen elephant trunk: overcoming the challenges. THE JOURNAL OF CARDIOVASCULAR SURGERY 2022; 63:434-438. [PMID: 35621062 DOI: 10.23736/s0021-9509.22.12385-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
The introduction of the single-step hybrid frozen elephant trunk (FET) procedure expanded the surgeon's armamentarium in managing aortic dissection (AD). This is evident by the reduction in mortality and complication rates associated with conventional techniques used to repair ADs. Although FET still carries a risk of certain complications, it has been associated with excellent aortic remodeling following the procedure. The main scope of this review is to evaluate aortic remodeling in aortic dissection after FET as well as to highlight the challenges that may arise and ways to overcome them. A comprehensive literature search was conducted on multiple electronic databases including PubMed, Ovid, Scopus and Embase to highlight the evidence in the literature on aortic remodeling in aortic dissection after FET. The FET procedure promotes excellent long-term remodeling, this is seen in the substantial increase in the size of the true lumen along with the decrease in that of the false lumen (FL), in addition to significant FL thrombosis. However, this occurs to a lesser extent more distally at the level of the abdominal aorta. Negative remodeling may present a major challenge to the process of aortic remodeling, nevertheless, this can be overcome with endovascular reintervention which has demonstrated highly favorable results. Additionally, the choice of FET graft, in terms of type and length, seems to influence outcomes. Namely, the Thoraflex™ Hybrid graft can be considered the superior graft on the global market. On the other hand, there seems to be a debate in the literature on the optimal FET graft length. The FET procedure has revolutionized the field of aortovascular surgery and promotes excellent long-term aortic remodeling. Negative remodeling can occur but can also be favorably overcome with endovascular reintervention. Finally, the choice of FET graft may also influence results, thus, should be taken with great care.
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Affiliation(s)
- Fatima Kayali
- School of Medicine, University of Central Lancashire, Preston, UK
| | - Matti Jubouri
- Hull York Medical School, University of York, York, UK
| | - Sven Z Tan
- Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Idhrees Mohammed
- Institute of Cardiac and Aortic Disorders (ICAD), SRM Institutes for Medical Science (SIMS Hospital), Chennai, India
| | - Mohamad Bashir
- Department of Vascular and Endovascular Surgery, Velindre University NHS Trust, Health Education and Improvement Wales (HEIW), Cardiff, UK -
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Wada T, Yamamoto H, Takagi D, Kadohama T, Yamaura G, Kiryu K, Igarashi I. Aortic remodeling, reintervention, and survival after zone 0 arch repair with frozen elephant trunks for acute type A aortic dissection: Midterm results. JTCVS Tech 2022; 14:29-38. [PMID: 35967231 PMCID: PMC9366877 DOI: 10.1016/j.xjtc.2022.05.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 05/24/2022] [Indexed: 12/13/2022] Open
Abstract
Objectives To investigate the midterm results after zone 0 arch repair with frozen elephant trunks for acute type A aortic dissection. Methods Between October 2014 and April 2021, 196 patients underwent zone 0 arch repair with frozen elephant trunks for acute type A aortic dissection. The true lumen area, aortic lumen area, and false lumen status were assessed at four aortic levels, the proximal and distal descending thoracic aorta (level A and level B, respectively), celiac artery branching (level C), and terminal aorta (level D). Aortic remodeling (postoperative area as a percentage of the preoperative area) was classified into 3 groups, positive (true lumen area ≥120% with aortic lumen <120% or true lumen area ≥80% with aortic lumen <80%), minimal (80% ≤ true lumen area and aortic lumen area <120%), and negative remodeling (all other changes). Results In-hospital mortality was 13 (6.6%) patients. The overall survival rate was 85.1% at 5 years. The freedom from distal aortic reintervention was 89.9% at 5 years. The prevalence of completely thrombosed or obliterated false lumen at 2 years was 96.8% at level A, 88.4% at level B, 47.2% at level C, and 27.6% at level D. The prevalence of positive aortic remodeling at 2 years was 84.7% at level A, 75.0% at level B, 29.2% at level C, and 16.7% at level D. Conclusions Zone 0 arch repair with frozen elephant trunks for acute type A aortic dissection can avoid invasive aortic arch resection and facilitate aortic remodeling of the descending thoracic aorta. The FET effect on aortic remodeling is limited at the aortic level below the FET stent end.
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Key Words
- AL, aortic lumen
- ATAAD, acute type A aortic dissection
- CPB, cardiopulmonary bypass
- CT, computed tomography
- FET, frozen elephant trunk
- FL, false lumen
- TAR, total arch replacement
- TEVAR, thoracic endovascular aortic repair
- TL, true lumen
- Z-0-FET, zone 0 arch repair with frozen elephant trunk
- acute type A aortic dissection
- aortic remodeling
- dSINE, distal stent graft-induced new entry
- distal stent-induced new entry
- frozen elephant trunk
- zone 0 arch repair
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Affiliation(s)
- Takuya Wada
- Department of Cardiovascular Surgery, Akita University Graduate School of Medicine, Akita, Japan
| | - Hiroshi Yamamoto
- Department of Cardiovascular Surgery, Akita University Graduate School of Medicine, Akita, Japan
| | - Daichi Takagi
- Department of Cardiovascular Surgery, Akita University Graduate School of Medicine, Akita, Japan
| | - Takayuki Kadohama
- Department of Cardiovascular Surgery, Akita University Graduate School of Medicine, Akita, Japan
| | - Gembu Yamaura
- Department of Cardiovascular Surgery, Akita University Graduate School of Medicine, Akita, Japan
| | - Kentaro Kiryu
- Department of Cardiovascular Surgery, Akita University Graduate School of Medicine, Akita, Japan
| | - Itaru Igarashi
- Department of Cardiovascular Surgery, Akita University Graduate School of Medicine, Akita, Japan
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Wang J, Jin T, Chen B, Pan Y, Shao C. Systematic review and meta-analysis of current evidences in endograft therapy versus medical treatment for uncomplicated type B aortic dissection. J Vasc Surg 2022; 76:1099-1108.e3. [PMID: 35390485 DOI: 10.1016/j.jvs.2022.03.876] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 03/26/2022] [Indexed: 01/16/2023]
Abstract
OBJECTIVE Best medical therapy (BMT) should be recommended for treating uncomplicated Stanford type B aortic dissection (uSTBAD), whereas thoracic aortic endovascular repair (TEVAR) has been controversial for uSTBAD. METHODS In this paper, a meta-analysis was conducted on all available randomized controlled trials and observational studies that evaluated the relative benefits and harms of TEVAR and BMT for the management of patients suffering from uSTBAD. Primary endpoints consisted of early adverse events, long-term adverse events and aortic remodeling. In addition, Risk difference (RD) or Odds ratios (OR) with 95% confidence intervals (CI) were estimated. The random effects model or the fixed-effects model was used in accordance with the 50% heterogeneity threshold. RESULTS Seven observational studies and two RCT studies from 11 articles that contained 15066 patients suffering from uSTBAD (1518 TEVARs) met the inclusion criteria. For early outcomes, no significant differences were found between the TEVAR group and the BMT group in aortic rupture, retrograde dissection, paraplegia/paraparesis, reintervention, aorta-related death and all caused death. In the long run, the TEVAR group was found to have a significantly lower incidence of adverse events, which included aortic rupture (OR:0.26, CI:0.16∼0.42, P<0.05; heterogeneity: P=0.90, I2=0%), reintervention (OR:0.45, CI:0.26∼0.75, P<0.05; heterogeneity: P=0.17, I2=41%), aorta-related death (OR:0.27, CI:0.18∼0.42, P<0.05; heterogeneity: P=0.61, I2=0%) and all caused death (OR:0.52, CI:0.42∼0.66, P<0.05; heterogeneity: P=0.05, I2=53%) as compared with the BMT group. Moreover, in compared with BMT, TEVAR was found to significantly contribute to the complete thrombosis of thoracic false lumen (OR:55.34, CI:34.32∼89.21, P<0.05; heterogeneity: P=0.97, I2=0%) and aortic regression (true lumen expansion and false lumen shrinkage). CONCLUSIONS Although early endovascular repair of uSTBAD does not outperform BMT, its implementation is found to be necessary to facilitate the long-term prognosis. Accordingly, if early TEVAR is to be deferred, close follow-up is critical to allow for timely reintervention.
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Affiliation(s)
- Jian Wang
- The Second Affiliated Hospital of Zhejiang University's Medical College, Department of Vascular Surgery, Hangzhou 310051, Zhejiang, China.
| | - Tao Jin
- The West China Medical School of Sichuan University, Chengdu 610041, Sichuan, China
| | - Bing Chen
- The Second Affiliated Hospital of Zhejiang University's Medical College, Department of Vascular Surgery, Hangzhou 310051, Zhejiang, China.
| | - Yifeng Pan
- The Second Affiliated Hospital of Zhejiang University's Medical College, Department of Vascular Surgery, Hangzhou 310051, Zhejiang, China
| | - Changming Shao
- The Second Affiliated Hospital of Zhejiang University's Medical College, Department of Vascular Surgery, Hangzhou 310051, Zhejiang, China
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Li Y, Li Z, Feng J, Feng R, Zhou J, Jing Z. A Novel Solution for Distal Dilation of Chronic Dissection After Repair Involving Visceral Branches: The Road Block Strategy. Front Cardiovasc Med 2022; 9:821260. [PMID: 35355962 PMCID: PMC8959700 DOI: 10.3389/fcvm.2022.821260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 01/31/2022] [Indexed: 12/02/2022] Open
Abstract
Aim Notwithstanding that unprecedented endovascular progress has been achieved in recent years, it remains unclear what is the best strategy to preserve the blood perfusion of abdominal visceral arteries and promote positive aortic remodeling in patients with distal dilatation of chronic aortic dissection in abdominal visceral part (CADAV) after aortic repair. The present study developed a Road Block Strategy (RBS) to solve this conundrum. Methods and Results This prospective single-center clinical study included patients suffering from symptomatic distal dilatation of CADAV after aortic repair treated with RBS from January 2015 to December 2019 and followed up regularly for at least 2 years. Stent grafts were implanted first to cover distal tears and expand the true lumen. Device embolization was performed to induce proximal and distal segmental false lumen thrombosis (FLT) apart from the level of the ostia of vital branches. Successful RBS was performed in 13 patients. Significant differences were found in maximum true lumen diameter (p < 0.05), blood flow area in false lumen (FL) (p < 0.001), and the ratio of blood lumen to FL area (p < 0.05) between the pre-procedure and the latest follow-up results. No aortic rupture, vital branches occlusion, thoracic and abdominal pain, or death occurred during hospitalization and follow-up. Conclusions Our findings suggest that RBS is feasible in treating distal dilatation of chronic aortic dissection after prior proximal repair, inducing false lumen thrombosis, preventing deterioration of aortic dissection, and maintaining the patency of abdominal visceral arteries.
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Affiliation(s)
- Yiming Li
- Department of Cardiology, General Hospital of Northern Theater Command, Shenyang, China
- Endovascular Diagnosis and Treatment Center for Aortic Diseases, Department of Vascular Surgery, Changhai Hospital, Navy Medical University, Shanghai, China
| | - Zhenjiang Li
- Department of Vascular Surgery, The First Affiliated Hospital of the Medical School of Zhejiang University, Hangzhou, China
| | - Jiaxuan Feng
- Endovascular Diagnosis and Treatment Center for Aortic Diseases, Department of Vascular Surgery, Changhai Hospital, Navy Medical University, Shanghai, China
| | - Rui Feng
- Department of Vascular Surgery, Shanghai General Hospital, Affiliated to Shanghai Jiaotong University, Shanghai, China
| | - Jian Zhou
- Endovascular Diagnosis and Treatment Center for Aortic Diseases, Department of Vascular Surgery, Changhai Hospital, Navy Medical University, Shanghai, China
- *Correspondence: Zaiping Jing
| | - Zaiping Jing
- Endovascular Diagnosis and Treatment Center for Aortic Diseases, Department of Vascular Surgery, Changhai Hospital, Navy Medical University, Shanghai, China
- Jian Zhou
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Bossone E, Gorla R, Ranieri B, Russo V, Jakob H, Erbel R. A New Era of Diagnosis and Therapy in Acute Aortic Syndromes: The Mainz-Essen Experience (Part II)-Management and Outcomes. AORTA (STAMFORD, CONN.) 2021; 9:201-214. [PMID: 34963160 PMCID: PMC8714317 DOI: 10.1055/s-0041-1739466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 07/02/2021] [Indexed: 10/25/2022]
Abstract
Over the years, the cardiovascular department of Johannes Gutenberg University in Mainz-West-German Heart Centre in Essen (Germany) designed and implemented the hybrid operating room (2003) along with advanced endovascular and surgical procedures, including the frozen elephant trunk technique. For the study purpose, the Mainz-Essen experience on acute aortic syndromes was summarized by considering original articles from single-center or multicenter studies performed at West German Heart Centre, Essen, Germany, or at the cardiovascular department of Johannes Gutenberg University, Mainz, Germany. We present the 35-year-long Mainz-Essen research, education, and patient management journey in creating an integrated multidisciplinary "Aortic Center" in the heart of Europe.
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Affiliation(s)
- Eduardo Bossone
- Division of Cardiology, Antonio Cardarelli Hospital, Naples, Italy
| | - Riccardo Gorla
- Department of Cardiology, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Brigida Ranieri
- Cardiovascular Imaging Division, IRCCS SDN (Scientific Institute for Research, Hospitalization and Healthcare), Naples, Italy
| | - Valentina Russo
- Department of Advanced Biomedical Sciences, Federico II University of Naples, Naples, Italy
| | - Heinz Jakob
- Department of Thoracic and Cardiovascular Surgery, West German Heart Center, University of Duisburg-Essen, University Hospital Essen, Essen, Germany
| | - Raimund Erbel
- Institute for Medical Informatics, Biometry and Epidemiology (IMIBE), University of Duisburg-Essen, University Hospital Essen, Essen, Germany
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Wan Ab Naim WN, Sun Z, Liew YM, Chan BT, Jansen S, Lei J, Ganesan PB, Hashim SA, Sridhar GS, Lim E. Comparison of diametric and volumetric changes in Stanford type B aortic dissection patients in assessing aortic remodeling post-stent graft treatment. Quant Imaging Med Surg 2021; 11:1723-1736. [PMID: 33936960 DOI: 10.21037/qims-20-814] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background The study aims to analyze the correlation between the maximal diameter (both axial and orthogonal) and volume changes in the true (TL) and false lumens (FL) after stent-grafting for Stanford type B aortic dissection. Method Computed tomography angiography was performed on 13 type B aortic dissection patients before and after procedure, and at 6 and 12 months follow-up. The lumens were divided into three regions: the stented area (Region 1), distal to the stent graft to the celiac artery (Region 2), and between the celiac artery and the iliac bifurcation (Region 3). Changes in aortic morphology were quantified by the increase or decrease of diametric and volumetric percentages from baseline measurements. Results At Region 1, the TL diameter and volume increased (pre-treatment: volume =51.4±41.9 mL, maximal axial diameter =22.4±6.8 mm, maximal orthogonal diameter =21.6±7.2 mm; follow-up: volume =130.7±69.2 mL, maximal axial diameter =40.1±8.1 mm, maximal orthogonal diameter =31.9+2.6 mm, P<0.05 for all comparisons), while FL decreased (pre-treatment: volume =129.6±150.5 mL; maximal axial diameter =43.0±15.8 mm; maximal orthogonal diameter =28.3±12.6 mm; follow-up: volume =66.6±95.0 mL, maximal axial diameter =24.5±19.9 mm, maximal orthogonal diameter =16.9±13.7, P<0.05 for all comparisons). Due to the uniformity in size throughout the vessel, high concordance was observed between diametric and volumetric measurements in the stented region with 93% and 92% between maximal axial diameter and volume for the true/false lumens, and 90% and 92% between maximal orthogonal diameter and volume for the true/false lumens. Large discrepancies were observed between the different measurement methods at regions distal to the stent graft, with up to 46% differences between maximal orthogonal diameter and volume. Conclusions Volume measurement was shown to be a much more sensitive indicator in identifying lumen expansion/shrinkage at the distal stented region.
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Affiliation(s)
- Wan Naimah Wan Ab Naim
- Faculty of Mechanical and Automotive Engineering Technology, University Malaysia Pahang, 26600, Pekan, Pahang, Malaysia
| | - Zhonghua Sun
- Discipline of Medical Radiation Science, Curtin University, Perth 6845, Australia
| | - Yih Miin Liew
- Department of Biomedical Engineering, Faculty of Engineering, University of Malaya, 50603 Kuala Lumpur, Malaysia
| | - Bee Ting Chan
- Department of Mechanical, Materials and Manufacturing, Faculty of Science and Engineering, University of Nottingham Malaysia, 43500 Semenyih, Selangor, Malaysia
| | - Shirley Jansen
- Department of Vascular Surgery, Sir Charles Gairdner Hospital, Nedlands, Perth WA 6009, Australia.,Curtin Medical School, Curtin University, Perth 6845, Australia.,University of Western Australia, Crawley WA 6009, Australia
| | - Jing Lei
- Department of Medical Imaging, First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Poo Balan Ganesan
- Department of Mechanical Engineering, Faculty of Engineering, University of Malaya, 50603 Kuala Lumpur, Malaysia
| | - Shahrul Amry Hashim
- Department of Surgery, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia
| | | | - Einly Lim
- Department of Biomedical Engineering, Faculty of Engineering, University of Malaya, 50603 Kuala Lumpur, Malaysia
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Pepe A, Li J, Rolf-Pissarczyk M, Gsaxner C, Chen X, Holzapfel GA, Egger J. Detection, segmentation, simulation and visualization of aortic dissections: A review. Med Image Anal 2020; 65:101773. [DOI: 10.1016/j.media.2020.101773] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Revised: 06/01/2020] [Accepted: 07/06/2020] [Indexed: 12/16/2022]
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9
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Yuan X, Mitsis A, Semple T, Rubens M, Nienaber CA. Dual lumen intervention for aortic dissection: long-term impact on aortic remodeling. ITALIAN JOURNAL OF VASCULAR AND ENDOVASCULAR SURGERY 2020. [DOI: 10.23736/s1824-4777.20.01441-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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10
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Song C, Yu G, Feng X, Feng R, Bao J, Zhao Z, Pei Y, Jing Z, Lu Q. Impact of high blood pressure variability on the occurrence of acute type B aortic dissection. Vascular 2020; 28:413-420. [PMID: 32216536 DOI: 10.1177/1708538120902630] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background Acute type B aortic dissection is a life-threatening medical emergency, and hypertension is believed to be an important predictor of aortic dissection; the impact of blood pressure variability on the onset and development of aortic dissection has attracted increasing attention. Methods A total of 120 acute type B aortic dissection patients and 57 hypertensive patients without aortic dissection were consecutively enrolled and retrospectively reviewed between January 2013 and November 2015. There were 60 acute type B aortic dissection patients in both high and low blood pressure variability groups. Results Blood pressure variability showed higher diagnostic value than hypertension in aortic dissection, and the best threshold of blood pressure variability is 5.71 mmHg. By performing multivariable logistic regression, we found that the history of hypertension was likely to be a risk factor of blood pressure variability (95% CI: 1.155–6.422, P = 0.022). Nine patients from high blood pressure variability group and two from low blood pressure variability group ( χ2 = 4.90, P = 0.027) received emergency surgery within 24 hours after admission. The presence of multiple tears (>2, 55.0% vs. 45.0%, P = 0.001), configuration of the false lumen (spiral false lumen) (50.0% vs. 21.7%, P = 0.001), the diameter of the false lumen (49.6 ± 15.0 mm vs. 37.6 ± 10.8 mm, P < 0.001), the false/true lumen ratio (1.53 ± 1.02 vs. 0.929 ± 0.733, P < 0.001), and the number of visceral arteries involved (1.75 ± 0.942 vs. 0.800 ± 0.927, P < 0.001) showed significant differences between high and low blood pressure variability groups. Nine (30%) patients from the high blood pressure variability group showed a maximum diameter of false lumen over 60 mm, while none was found in the low blood pressure variability group. Conclusions High blood pressure variability, the presence of multiple tears (>2), the configuration of false lumen, the diameter of the false lumen, false/true lumen ratio, and the number of visceral arteries involved were independent risk factors for acute type B aortic dissection.
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Affiliation(s)
- Chao Song
- Department of Vascular Surgery, Shanghai Changhai Hospital, Shanghai, China
| | - Guanyu Yu
- Department of Colorectal Surgery, Shanghai Changhai Hospital, Shanghai, China
| | - Xiang Feng
- Department of Urology, Shanghai Changhai Hospital, Shanghai, China
| | - Rui Feng
- Department of Vascular Surgery, Shanghai Changhai Hospital, Shanghai, China
| | - Junmin Bao
- Department of Vascular Surgery, Shanghai Changhai Hospital, Shanghai, China
| | - Zhiqing Zhao
- Department of Vascular Surgery, Shanghai Changhai Hospital, Shanghai, China
| | - Yifei Pei
- Department of Vascular Surgery, Shanghai Changhai Hospital, Shanghai, China
| | - Zaiping Jing
- Department of Vascular Surgery, Shanghai Changhai Hospital, Shanghai, China
| | - Qingsheng Lu
- Department of Vascular Surgery, Shanghai Changhai Hospital, Shanghai, China
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Hsieh RW, Hsu TC, Lee M, Hsu WT, Chen ST, Huang AH, Hsieh AL, Lee CC. Comparison of type B dissection by open, endovascular, and medical treatments. J Vasc Surg 2019; 70:1792-1800.e3. [DOI: 10.1016/j.jvs.2019.02.062] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Accepted: 02/27/2019] [Indexed: 01/16/2023]
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12
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Lescan M, Czerny M, Berezowski M, Andic M, Bamberg F, Beyersdorf F, Schlensak C, Rylski B. Morphologic performance analysis of the Relay nonbare stent graft in dissected thoracic aorta. J Vasc Surg 2019; 70:1390-1398. [DOI: 10.1016/j.jvs.2019.02.026] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Accepted: 02/07/2019] [Indexed: 11/30/2022]
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13
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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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Rylski B, Muñoz C, Beyersdorf F, Siepe M, Reser D, Carrel T, Schoenhoff F, Schlensak C, Lescan M, Eckstein HH, Reutersberg B, Erbel R, Janosi RA, Czerny M. How does descending aorta geometry change when it dissects? Eur J Cardiothorac Surg 2019; 53:815-821. [PMID: 28958027 DOI: 10.1093/ejcts/ezx292] [Citation(s) in RCA: 49] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2017] [Accepted: 07/15/2017] [Indexed: 01/06/2023] Open
Abstract
OBJECTIVES Thoracic endovascular aortic repair is the treatment of choice in complicated acute type B aortic dissection. How to infer predissection aortic diameter is not well understood. Our aim was to delineate changes in descending aortic geometry due to dissection. METHODS Five tertiary centres reviewed their acute aortic dissection type B databases containing 802 patients. All patients who had undergone computed tomography angiography less than 2 years before and immediately after aortic dissection onset were included. We compared the aortic geometry before and after the dissection onset. RESULTS Altogether 25 patients were included [median age 60 (first quartile 52, third quartile 72) years; 60% men]. In all except 1 patient, the maximum descending aortic diameter was less than 45 mm before aortic dissection onset. The largest increase in diameter induced by the dissection was observed in the proximal descending aorta 28.2 (25.1, 32.1) vs 34.6 (31.3, 39.1) mm (+6.4 mm; +23%; P < 0.001). The thoracic descending aortic length increased after the dissection onset [253.3 (229.3, 271.9) vs 261.3 (247.9, 285.4) mm; P = 0.003]. The predissection aortic diameter of the proximal thoracic descending aorta was 7.9 (5.2, 10.7) mm larger (P < 0.001) than the post-dissection area-derived true-lumen diameter and 2.5 (1.3, 6.1) mm larger than the maximum true-lumen diameter (P < 0.001). CONCLUSIONS Type B aortic dissection increases the diameter, length and volume of the descending thoracic aorta. The predissection aortic diameter most closely resembles the post-dissection maximum diameter of the true lumen.
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Affiliation(s)
- Bartosz Rylski
- Department of Cardiovascular Surgery, Heart Center Freiburg University, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Camila Muñoz
- Department of Cardiovascular Surgery, Heart Center Freiburg University, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Friedhelm Beyersdorf
- Department of Cardiovascular Surgery, Heart Center Freiburg University, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Matthias Siepe
- Department of Cardiovascular Surgery, Heart Center Freiburg University, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Diana Reser
- Division of Cardiovascular Surgery, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Thierry Carrel
- Department of Cardiovascular Surgery, University Hospital Berne, Berne, Switzerland
| | - Florian Schoenhoff
- Department of Cardiovascular Surgery, University Hospital Berne, Berne, Switzerland
| | - Christian Schlensak
- Department of Thoracic, Cardiac and Vascular Surgery, University Hospital Tübingen, Tübingen, Germany
| | - Mario Lescan
- Department of Thoracic, Cardiac and Vascular Surgery, University Hospital Tübingen, Tübingen, Germany
| | - Hans-Henning Eckstein
- Department for Vascular and Endovascular Surgery, Klinikum rechts der Isar, Technical University Munich, Munich, Germany
| | - Benedikt Reutersberg
- Department for Vascular and Endovascular Surgery, Klinikum rechts der Isar, Technical University Munich, Munich, Germany
| | - Raimund Erbel
- Institute of Medical Informatics, Biometry and Epidemiology, University Clinic Essen, University Duisburg-Essen, Essen, Germany
| | - Rolf Alexander Janosi
- Department of Cardiology, West-German Heart and Vascular Center Essen, University Hospital Essen, Essen, Germany
| | - Martin Czerny
- Department of Cardiovascular Surgery, Heart Center Freiburg University, Faculty of Medicine, University of Freiburg, Freiburg, Germany
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Saremi F, Hassani C, Lin LM, Lee C, Wilcox AG, Fleischman F, Cunningham MJ. Image Predictors of Treatment Outcome after Thoracic Aortic Dissection Repair. Radiographics 2018; 38:1949-1972. [DOI: 10.1148/rg.2018180025] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Farhood Saremi
- From the Departments of Radiology (F.S., C.H., L.M.L., C.L., A.G.W.) and Cardiovascular Surgery (C.H., F.F., M.J.C.), University of Southern California, USC University Hospital, 1500 San Pablo St, Los Angeles, CA 90033
| | - Cameron Hassani
- From the Departments of Radiology (F.S., C.H., L.M.L., C.L., A.G.W.) and Cardiovascular Surgery (C.H., F.F., M.J.C.), University of Southern California, USC University Hospital, 1500 San Pablo St, Los Angeles, CA 90033
| | - Leah M. Lin
- From the Departments of Radiology (F.S., C.H., L.M.L., C.L., A.G.W.) and Cardiovascular Surgery (C.H., F.F., M.J.C.), University of Southern California, USC University Hospital, 1500 San Pablo St, Los Angeles, CA 90033
| | - Christopher Lee
- From the Departments of Radiology (F.S., C.H., L.M.L., C.L., A.G.W.) and Cardiovascular Surgery (C.H., F.F., M.J.C.), University of Southern California, USC University Hospital, 1500 San Pablo St, Los Angeles, CA 90033
| | - Alison G. Wilcox
- From the Departments of Radiology (F.S., C.H., L.M.L., C.L., A.G.W.) and Cardiovascular Surgery (C.H., F.F., M.J.C.), University of Southern California, USC University Hospital, 1500 San Pablo St, Los Angeles, CA 90033
| | - Fernando Fleischman
- From the Departments of Radiology (F.S., C.H., L.M.L., C.L., A.G.W.) and Cardiovascular Surgery (C.H., F.F., M.J.C.), University of Southern California, USC University Hospital, 1500 San Pablo St, Los Angeles, CA 90033
| | - Mark J. Cunningham
- From the Departments of Radiology (F.S., C.H., L.M.L., C.L., A.G.W.) and Cardiovascular Surgery (C.H., F.F., M.J.C.), University of Southern California, USC University Hospital, 1500 San Pablo St, Los Angeles, CA 90033
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16
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Kazimierczak A, Jedrzejczak T, Rynio P, Waligórski S. Favorable remodeling after hybrid arch debranching and modified provisional extension to induce complete attachment technique in type a aortic dissection: A case report. Medicine (Baltimore) 2018; 97:e12409. [PMID: 30213017 PMCID: PMC6155974 DOI: 10.1097/md.0000000000012409] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
RATIONALE Type A aortic dissection (TAAD) usually requires emergency open repair of the ascending aorta. In cases of diffuse dissection that spreads along the descending and abdominal aorta (type I, DeBakey classification), the risk of aneurysmal degeneration varies between 30% and 50% during 5 years and increases even higher during a longer follow-up. Those patients might require complex intervention to prevent aortic rupture. A combination of hybrid arch debranching and the extended provisional extension to induce complete attachment (e-PETTICOAT) technique might be an available alternative in such cases. This is the first report of the successful use of the e-PETTICOAT technique for treating degenerative, diffuse TAAD. PATIENT CONCERNS Acute chest pain and syncope were the initial symptoms of diffuse TAAD in our 66-year-old female patient. Open replacement of the ascending aorta followed by surgical arch debranching was performed as a staged procedure. Unfortunately, progressive aneurysmal degeneration was revealed 6 months later in the thoracic, abdominal, and infrarenal aorta with the recurrence of chest and lumbar pain. DIAGNOSES Computed angiotomography revealed severe aneurysmal degeneration of aortic dissection in the thoracic and abdominal aorta. INTERVENTION The e-PETTICOAT enabled good remodeling and stopped degeneration. OUTCOME At the 2-year follow-up, good remodeling with complete false lumen thrombosis and a stable aortic size were confirmed. LESSON Lifelong follow-up in extensive TAAD should be considered. The e-PETTICOAT technique is an available alternative to fenestrated endovascular aortic repair for degenerative TAAD, as it promotes favorable remodeling after successful surgery of the ascending aorta.
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Affiliation(s)
| | - Tomasz Jedrzejczak
- Department of Cardiosurgery, Pomeranian Medical University in Szczecin, Szczecin, Poland
| | | | - Szymon Waligórski
- Department of Cardiosurgery, Pomeranian Medical University in Szczecin, Szczecin, Poland
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17
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Maeda K, Ohki T, Kanaoka Y. Endovascular Treatment of Various Aortic Pathologies: Review of the Latest Data and Technologies. Int J Angiol 2018; 27:81-91. [PMID: 29896040 DOI: 10.1055/s-0038-1645881] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
The technologies and innovations applicable to endovascular treatment for complex aortic pathologies have progressed rapidly over the last two decades. Although the initial outcomes of an endovascular aortic repair have been excellent, as long-term data became available, complications including endoleaks, endograft migration, and endograft infection have become apparent and are of concern. Previously, the indication for endovascular therapy was restricted to descending thoracic aortic aneurysms and abdominal aortic aneurysms. However, its indication has expanded along with the improvement of techniques and devices, and currently, it has become possible to treat pararenal aortic aneurysms and Crawford type 4 thoracoabdominal aortic aneurysm (TAAA) using the off-the-shelf devices. Additionally, custom-made devices allow for the treatment of arch or more extensive TAAAs. Endovascular treatment is applied not only to aneurysms but also to acute/chronic dissections. However, long-term outcomes are still unclear. This article provides an overview of available devices and the results of endovascular treatment for various aortic pathologies.
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Affiliation(s)
- Koji Maeda
- Division of Vascular Surgery, Department of Surgery, Jikei University School of Medicine, Tokyo, Japan
| | - Takao Ohki
- Division of Vascular Surgery, Department of Surgery, Jikei University School of Medicine, Tokyo, Japan
| | - Yuji Kanaoka
- Division of Vascular Surgery, Department of Surgery, Jikei University School of Medicine, Tokyo, Japan
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18
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False lumen intervention to promote remodelling and thrombosis-The FLIRT concept in aortic dissection. Catheter Cardiovasc Interv 2018; 92:732-740. [DOI: 10.1002/ccd.27599] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2017] [Revised: 02/01/2018] [Accepted: 02/23/2018] [Indexed: 01/16/2023]
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19
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Samanidis G, Kanakis M, Ieromonachos C, Stavridis G. Complete Shrinkage of the Obliterated False Lumen After Open and Endovascular Chronic Aortic Dissection Stanford Type A Repair. AORTA : OFFICIAL JOURNAL OF THE AORTIC INSTITUTE AT YALE-NEW HAVEN HOSPITAL 2017; 5:61-63. [PMID: 28868318 DOI: 10.12945/j.aorta.2017.16.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/09/2016] [Accepted: 03/12/2017] [Indexed: 11/18/2022]
Abstract
A 48-year-old man was admitted to our hospital with chronic aortic dissection Stanford Type A. His diagnosis was confirmed by chest multi-detector computed tomography (CT). The patient underwent combined (i.e., hybrid) open and endovascular repair (frozen elephant trunk) in a one-stage operation with moderate hypothermic circulatory arrest and antegrade cerebral perfusion. His postoperative course was uneventful, and he was discharged home on postoperative day 9. At 2-year follow-up, chest CT angiography revealed complete shrinkage of the obliterated false lumen in the distal aortic arch and descending thoracic aorta.
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Affiliation(s)
- George Samanidis
- Department of Cardiac Surgery, Onassis Cardiac Surgery Center, Athens, Greece
| | - Meletios Kanakis
- Department of Cardiac Surgery, Onassis Cardiac Surgery Center, Athens, Greece
| | | | - George Stavridis
- Department of Cardiac Surgery, Onassis Cardiac Surgery Center, Athens, Greece
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20
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Famularo M, Meyermann K, Lombardi JV. Aneurysmal degeneration of type B aortic dissections after thoracic endovascular aortic repair: A systematic review. J Vasc Surg 2017; 66:924-930. [DOI: 10.1016/j.jvs.2017.06.067] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Accepted: 06/15/2017] [Indexed: 11/16/2022]
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21
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Gorla R, Tsagakis K, Horacek M, Mahabadi AA, Kahlert P, Jakob H, Bossone E, Erbel R, Jánosi RA. Impact of Preoperative Anemia and Postoperative Hemoglobin Drop on the Incidence of Acute Kidney Injury and In-Hospital Mortality in Patients With Type B Acute Aortic Syndromes Undergoing Thoracic Endovascular Aortic Repair. Vasc Endovascular Surg 2017; 51:131-138. [PMID: 28330439 DOI: 10.1177/1538574417697211] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
BACKGROUND The impact of preoperative anemia and postoperative hemoglobin (Hb) drop on the incidence of acute kidney injury (AKI) after thoracic endovascular aortic repair (TEVAR) for type B acute aortic syndromes (AAS) as well as their prognostic value is unknown. METHODS This retrospective study included 144 patients with type B AAS undergoing TEVAR at our center. Preoperative anemia was classified as no/mild (Hb ≥ 12.0 g/dL in men; ≥11.3 g/dL in women), moderate (Hb 10.80-11.99 g/dL in men; 10.23-11.29 g/dL in women), and severe (<10.80 g/dL in men; <10.23 g/dL in women). Postoperative Hb drop was classified as mild (<2 g/dL), moderate (2-4 g/dL), and severe (>4 g/dL). End points of the study were postoperative AKI and in-hospital mortality. RESULTS Postoperative AKI was higher in the severe and moderate anemia groups than the no/mild anemia group (63.2%, 52.0%, and 31.0%, respectively, P = .01). In-hospital mortality and AKI were higher in patients with severe postoperative Hb drop (40.9% and 86.4%) than patients with moderate (6.9% and 36.2%) and mild (4.7% and 25.0%) postoperative Hb drop (both P < .001). Postoperative Hb drop (odds ratio [OR]:1.67, P = .036), postoperative Hb levels (OR: 0.57, P = .025), and mesenteric ischemia (OR: 4.65, P = .044) were identified as independent predictors of in-hospital mortality. Preoperative Hb (OR: 0.26, P = .001), postoperative Hb drop (OR: 4.34, P < .001), contrast medium (OR: 1.82, P = .004), and diabetes mellitus (OR: 3.79, P = .001) were independent predictors of AKI. At follow-up, anemia and postoperative Hb drop were not associated with increased mortality. CONCLUSION Preoperative Hb and postoperative Hb drop were significant risk factors for AKI. Postoperative Hb drop and Hb levels predicted in-hospital mortality.
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Affiliation(s)
- Riccardo Gorla
- 1 Department of Cardiology, West German Heart and Vascular Center Essen, University Duisburg-Essen, Essen, Germany.,2 University of Insubria, Varese, Italy
| | - Konstantinos Tsagakis
- 3 Department of Thoracic and Cardiovascular surgery, West German Heart and Vascular Center Essen, University Duisburg-Essen, Essen, Germany
| | - Michael Horacek
- 1 Department of Cardiology, West German Heart and Vascular Center Essen, University Duisburg-Essen, Essen, Germany
| | - Amir-Abbas Mahabadi
- 1 Department of Cardiology, West German Heart and Vascular Center Essen, University Duisburg-Essen, Essen, Germany
| | - Philipp Kahlert
- 1 Department of Cardiology, West German Heart and Vascular Center Essen, University Duisburg-Essen, Essen, Germany
| | - Heinz Jakob
- 3 Department of Thoracic and Cardiovascular surgery, West German Heart and Vascular Center Essen, University Duisburg-Essen, Essen, Germany
| | | | - Raimund Erbel
- 5 Institute of Medical Informatics, Biometrics and Epidemiology, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Rolf Alexander Jánosi
- 1 Department of Cardiology, West German Heart and Vascular Center Essen, University Duisburg-Essen, Essen, Germany
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22
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Abstract
Stanford type B aortic dissections (TBADs) involve the descending aorta and can present with complications, including malperfusion syndrome or aortic rupture, which are associated with significant morbidity and mortality if left untreated. Clinical diagnosis is straightforward, typically confirmed using CT angiography. Treatment begins with immediate anti-impulse medical therapy. Acute TBAD with complications should be repaired with emergent thoracic endovascular aortic repair (TEVAR). Uncomplicated TBAD with high-risk features should undergo TEVAR in the subacute phase. Open surgical repair is seldom required and reserved only for select cases. It is critical to follow these patients clinically and radiographically in the outpatient setting.
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Affiliation(s)
- Daniel B Alfson
- Division of Vascular Surgery, Department of Surgery, Keck School of Medicine of USC, University of Southern California, 1520 San Pablo Street, HCC II, Suite 4300, Los Angeles, CA 90033-5330, USA
| | - Sung W Ham
- Division of Vascular Surgery, Department of Surgery, Keck School of Medicine of USC, University of Southern California, 1520 San Pablo Street, HCC II, Suite 4300, Los Angeles, CA 90033-5330, USA.
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Factors Related to Late False Lumen Enlargement after Thoracic Stent-Graft Placement for Type B Aortic Dissection. J Vasc Interv Radiol 2017; 28:44-49. [DOI: 10.1016/j.jvir.2016.09.021] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Revised: 08/31/2016] [Accepted: 09/14/2016] [Indexed: 11/19/2022] Open
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Wojtaszek M, Wnuk E, Maciag R, Lamparski K, Korzeniowski K, Rowinski O. Promoting False-Lumen Thrombosis after Thoracic Endovascular Aneurysm Repair in Type B Aortic Dissection by Selectively Excluding False-Lumen Distal Entry Tears. J Vasc Interv Radiol 2016; 28:168-175. [PMID: 27645464 DOI: 10.1016/j.jvir.2016.07.007] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2015] [Revised: 06/29/2016] [Accepted: 07/08/2016] [Indexed: 11/27/2022] Open
Abstract
PURPOSE To evaluate the efficacy and clinical outcomes of ancillary endovascular procedures in promoting false-lumen (FL) thrombosis (FLT) and preventing aortic expansion in patients after thoracic endografting for type B dissections. MATERIALS AND METHODS This retrospective review included 15 patients (12 men and 3 women; mean age, 59.6 y). Mean aortic diameter at the time of ancillary treatment was 47.4 mm. Different techniques were used as single procedures or sequentially: covered stent occlusion of detached visceral artery entry tears, occlusion of single entry tears with vascular plugs, or aortic endograft occlusion of multiple FL entry tears. FL embolization with ethylene vinyl alcohol copolymer was performed when selective occlusion was considered insufficient to close distal entry tears. Apart from endovascular aneurysm repair, all procedures were performed percutaneously under local anesthesia. If FL diameter increase persisted after 6-month follow-up computed tomographic (CT) angiography, another intervention was planned; otherwise, yearly follow-up was performed. RESULTS Mean clinical follow-up duration was 43.8 months (range, 8 d to 86.8 mo), with no in-hospital mortality. Estimated overall survival rates were 93.3%, 86.6%, and 77% at 12, 24, and 48 months, respectively. Three late deaths occurred, one of which was dissection-related at 40 months. Eight surviving patients (53%) had total FLT and 3 had partial FLT with stable aortic diameter on follow-up CT angiography. FL diameter increased in one patient, requiring further intervention. CONCLUSIONS Selective exclusion of new distal entry tears remaining after thoracic endovascular aneurysm repair can stabilize abdominal aortic expansion and promote FLT.
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Affiliation(s)
- Mikolaj Wojtaszek
- Second Department of Clinical Radiology, Medical University of Warsaw, Banacha 1A, Warsaw 02-097, Poland.
| | - Emilia Wnuk
- Second Department of Clinical Radiology, Medical University of Warsaw, Banacha 1A, Warsaw 02-097, Poland
| | - Rafal Maciag
- Second Department of Clinical Radiology, Medical University of Warsaw, Banacha 1A, Warsaw 02-097, Poland
| | - Krzysztof Lamparski
- Second Department of Clinical Radiology, Medical University of Warsaw, Banacha 1A, Warsaw 02-097, Poland
| | - Krzysztof Korzeniowski
- Second Department of Clinical Radiology, Medical University of Warsaw, Banacha 1A, Warsaw 02-097, Poland
| | - Olgierd Rowinski
- Second Department of Clinical Radiology, Medical University of Warsaw, Banacha 1A, Warsaw 02-097, Poland
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Affiliation(s)
- Vikalp Jain
- Department of Surgery, Division of Vascular Surgery, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, USA
| | - Mark A. Farber
- Department of Surgery, Division of Vascular Surgery, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, USA
| | - Raghuveer Vallabhaneni
- Department of Surgery, Division of Vascular Surgery, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, USA
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26
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Weber TF, Böckler D, Müller-Eschner M, Bischoff M, Kronlage M, von Tengg-Kobligk H, Kauczor HU, Hyhlik-Dürr A. Frequency of abdominal aortic expansion after thoracic endovascular repair of type B aortic dissection. Vascular 2016; 24:567-579. [DOI: 10.1177/1708538115627249] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Purpose To determine abdominal aortic expansion after thoracic endovascular aortic repair (TEVAR) in patients with aortic dissection type B and 36 months minimum follow-up. Methods Retrospective study of 18 TEVAR patients with follow-up >36 months. Abdominal aortic diameters at celiac trunk (location B) and infrarenal aorta (location C) were recorded on the first and last imaging after TEVAR. False lumen thrombosis was determined at level of endograft (A) and at B and C. Aortic expansion was defined as diameter increase of 5 mm or 15%. Correlation analyses were performed to investigate potential determinants of expansion. Results Median follow-up was 75.2 months. Sixteen of 18 patients (88.9%) demonstrated abdominal expansion. Mean expansion was 9.9 ± 6.1 mm at B and 11.7 ± 6.5 mm at C, without a difference between acute and chronic dissections. Critical diameters of 55 mm were reached in two patients treated for chronic dissection (11.1%). Annual diameter increase was significantly greater at locations with baseline diameters >30 mm (2.1 ± 1.1 mm vs. 1.0 ± 0.6 mm, p = 0.009). Baseline diameters were greater in patients with chronic dissections. Conclusion Abdominal aortic expansion can be frequently recognized after TEVAR for aortic dissection type B and occurs independently from thoracic false lumen thrombosis. Clinical significant abdominal aortic expansion may occur more frequently in patients treated with TEVAR for chronic dissection.
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Affiliation(s)
- Tim F Weber
- Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany
| | - Dittmar Böckler
- Vascular and Endovascular Surgery, University Hospital Heidelberg, Heidelberg, Germany
| | - Matthias Müller-Eschner
- Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany
| | - Moritz Bischoff
- Vascular and Endovascular Surgery, University Hospital Heidelberg, Heidelberg, Germany
| | - Moritz Kronlage
- Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany
| | - Hendrik von Tengg-Kobligk
- Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany
- Institute for Diagnostic, Interventional and Pediatric Radiology, Inselspital, University Medical Center Bern, Bern, Switzerland
| | - Hans-Ulrich Kauczor
- Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany
| | - Alexander Hyhlik-Dürr
- Vascular and Endovascular Surgery, University Hospital Heidelberg, Heidelberg, Germany
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27
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Kamman AV, van Herwaarden JA, Orrico M, Nauta FJH, Heijmen RH, Moll FL, Trimarchi S. Standardized Protocol to Analyze Computed Tomography Imaging of Type B Aortic Dissections. J Endovasc Ther 2016; 23:472-82. [DOI: 10.1177/1526602816642591] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Purpose: To propose a standard measuring protocol for type B aortic dissections so as to improve comparability between studies reporting aortic dimensions. Methods: Fifteen computed tomography (CT) scans of type B aortic dissections were measured with a standard protocol by 2 independent observers using postprocessing software. The following parameters were assessed: true, false, and total lumen diameter; true and false lumen volume; and entry tear size, location, and number. Diameters were measured in a perpendicular plane at 2, 10, and 20 cm from the left subclavian artery and 5 cm from the most distal renal artery. True lumen volume was assessed from the left subclavian artery to the aortic bifurcation, while the false lumen volume was from the start to end up to the aortic bifurcation. Entry tear location was assessed in relation to the left subclavian artery. Intra- and interobserver repeatability and agreement were evaluated using the Bland-Altman method, an a priori set of acceptable differences, and Lin’s concordance correlation coefficient (LCCC). Results: Intra- and interobserver mean differences for aortic diameter and true and false lumen volumes were generally within the limits of agreement and the a priori differences; the LCCC showed excellent agreement. Entry tear location, size, and number were difficult to measure in a repeatable manner, with inconsistent correlation coefficients, especially between the 2 observers. Conclusion: This protocol showed acceptable repeatability for aortic diameter and aortic volume measurements. Assessment of entry tears proved challenging and associated with less favorable results. Additionally, investigators are urged to be more transparent regarding the measurement methodology used in studies describing aortic dimensions.
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Affiliation(s)
- Arnoud V. Kamman
- Thoracic Aortic Research Center, Policlinico San Donato IRCCS, San Donato Milanese, Italy
- Department of Vascular Surgery, University Hospital Utrecht, the Netherlands
| | | | - Matteo Orrico
- Department of Vascular Surgery, San Filippo Neri Hospital, Rome, Italy
| | - Foeke J. H. Nauta
- Thoracic Aortic Research Center, Policlinico San Donato IRCCS, San Donato Milanese, Italy
- Department of Vascular Surgery, University Hospital Utrecht, the Netherlands
- Departments of Surgery and Biomedical Engineering, University of Michigan, Ann Arbor, MI, USA
| | - Robin H. Heijmen
- Department of Cardiothoracic Surgery, St. Antonius Hospital, Nieuwegein, the Netherlands
| | - Frans L. Moll
- Department of Vascular Surgery, University Hospital Utrecht, the Netherlands
| | - Santi Trimarchi
- Thoracic Aortic Research Center, Policlinico San Donato IRCCS, San Donato Milanese, Italy
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28
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Jánosi RA, Gorla R, Tsagakis K, Kahlert P, Horacek M, Bruckschen F, Dohle DS, Jakob H, Schlosser T, Eggebrecht H, Bossone E, Erbel R. Thoracic Endovascular Repair of Complicated Penetrating Aortic Ulcer. J Endovasc Ther 2015; 23:150-9. [PMID: 26511894 DOI: 10.1177/1526602815613790] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Purpose: To analyze an 11-year single-center experience of treating complicated penetrating aortic ulcer (PAU) using thoracic endovascular aortic repair (TEVAR). Methods: This study included 63 consecutive patients (mean age 69.1±11.5 years; 40 men) with complicated PAU (42 symptomatic, 22 with rupture) who underwent TEVAR between 2002 and 2013. The PAUs were located in the aortic arch (n=11), the descending thoracic aorta (n=43), and the thoracoabdominal aorta (n=9). Results: TEVAR was performed within 14 days of diagnosis in 33 (52.3%) cases (19 ruptures treated immediately); the other 30 (47.6%) patients had an average interval between diagnosis and intervention of 40±39 days. Technical success was 98.4% (62/63). One patient had a type I endoleak after stent-graft repair of a PAU in the aortic arch without great vessel transposition; another procedure was required for carotid-subclavian bypass and proximal stent-graft extension. No patient experienced spinal cord ischemia after TEVAR. Five (7.9%) patients died in-hospital; 3 had severe cardiac complications, 1 died from complications of aortic rupture, and the other succumbed to septic shock. Mean follow-up was 45.6±47.2 months, during which 12 (19.0%) patients needed a secondary intervention because of late endoleaks (n=4, 6.3%) or new complications due to disease progression. Multivariate analysis indicated that a PAU depth >15 mm was an independent predictor of mortality (hazard ratio 6.92, p=0.03). In the biomarker analysis, symptomatic patients had significantly higher D-dimer and troponin levels compared to asymptomatic patients [559.5±460.7 vs 283.2±85.2 µg/L (p=0.016) and 0.22±0.61 vs 0.02±0.03 ng/mL (p=0.04), respectively]. Conclusion: Patients with PAU suffer from underlying severe atherosclerotic disease and have a significant number of cardiovascular comorbidities that lead to relevant mortality and morbidity after TEVAR. As a PAU diameter >15 mm represented high risk for disease progression, these patients may be candidates for early intervention. D-dimer levels may help identify patients at risk and with progression of PAU.
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Affiliation(s)
- Rolf Alexander Jánosi
- Department of Cardiology, West-German Heart and Vascular Center Essen and University Duisburg-Essen, Essen, Germany
| | - Riccardo Gorla
- Department of Cardiology, West-German Heart and Vascular Center Essen and University Duisburg-Essen, Essen, Germany
| | - Konstantinos Tsagakis
- Department of Thoracic and Cardiovascular Surgery, West-German Heart and Vascular Center Essen and University Duisburg-Essen, Essen, Germany
| | - Philipp Kahlert
- Department of Cardiology, West-German Heart and Vascular Center Essen and University Duisburg-Essen, Essen, Germany
| | - Michael Horacek
- Department of Cardiology, West-German Heart and Vascular Center Essen and University Duisburg-Essen, Essen, Germany
| | - Florian Bruckschen
- Department of Cardiology, West-German Heart and Vascular Center Essen and University Duisburg-Essen, Essen, Germany
| | - Daniel-Sebastian Dohle
- Department of Thoracic and Cardiovascular Surgery, West-German Heart and Vascular Center Essen and University Duisburg-Essen, Essen, Germany
| | - Heinz Jakob
- Department of Thoracic and Cardiovascular Surgery, West-German Heart and Vascular Center Essen and University Duisburg-Essen, Essen, Germany
| | - Thomas Schlosser
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | | | | | - Raimund Erbel
- Institute of Medical Informatics, Biometry and Epidemiology (IMIBE), University Hospital Essen, University Duisburg-Essen, Essen, Germany
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Gorla R, Erbel R, Kahlert P, Tsagakis K, Jakob H, Mahabadi AA, Schlosser T, Eagle K, Bossone E, Jánosi RA. Clinical features and prognostic value of stent-graft-induced post-implantation syndrome after thoracic endovascular aortic repair in patients with type B acute aortic syndromes. Eur J Cardiothorac Surg 2015; 49:1239-47. [DOI: 10.1093/ejcts/ezv355] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2015] [Accepted: 07/31/2015] [Indexed: 01/05/2023] Open
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30
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Nauta FJH, Conti M, Kamman AV, van Bogerijen GHW, Tolenaar JL, Auricchio F, Figueroa CA, van Herwaarden JA, Moll FL, Trimarchi S. Biomechanical Changes After Thoracic Endovascular Aortic Repair in Type B Dissection. J Endovasc Ther 2015; 22:918-33. [DOI: 10.1177/1526602815608848] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Thoracic endovascular aortic repair (TEVAR) has evolved into an established treatment option for type B aortic dissection (TBAD) since it was first introduced 2 decades ago. Morbidity and mortality have decreased due to the minimally invasive character of TEVAR, with adequate stabilization of the dissection, restoration of true lumen perfusion, and subsequent positive aortic remodeling. However, several studies have reported severe setbacks of this technique. Indeed, little is known about the biomechanical behavior of implanted thoracic stent-grafts and the impact on the vascular system. This study sought to systematically review the performance and behavior of implanted thoracic stent-grafts and related biomechanical aortic changes in TBAD patients in order to update current knowledge and future perspectives.
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Affiliation(s)
- Foeke J. H. Nauta
- Thoracic Aortic Research Center, Policlinico San Donato IRCCS, University of Milan, Italy
- Departments of Surgery and Biomedical Engineering, University of Michigan, Ann Arbor, MI, USA
- Department of Vascular Surgery, University Medical Center Utrecht, the Netherlands
| | - Michele Conti
- Department of Civil Engineering and Architecture, University of Pavia, Italy
| | - Arnoud V. Kamman
- Thoracic Aortic Research Center, Policlinico San Donato IRCCS, University of Milan, Italy
- Departments of Surgery and Biomedical Engineering, University of Michigan, Ann Arbor, MI, USA
- Department of Vascular Surgery, University Medical Center Utrecht, the Netherlands
| | | | - Jip L. Tolenaar
- Department of General Surgery, St. Antonius Hospital, Nieuwegein, the Netherlands
| | | | - C. Alberto Figueroa
- Departments of Surgery and Biomedical Engineering, University of Michigan, Ann Arbor, MI, USA
| | | | - Frans L. Moll
- Department of Vascular Surgery, University Medical Center Utrecht, the Netherlands
| | - Santi Trimarchi
- Thoracic Aortic Research Center, Policlinico San Donato IRCCS, University of Milan, Italy
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31
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Zhang L, Tian W, Feng R, Song C, Zhao Z, Bao J, Liu A, Su D, Zhou J, Jing Z. Prognostic Impact of Blood Pressure Variability on Aortic Dissection Patients After Endovascular Therapy. Medicine (Baltimore) 2015; 94:e1591. [PMID: 26402822 PMCID: PMC4635762 DOI: 10.1097/md.0000000000001591] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
Hypertension has been deemed as a pivotal risk factor for the development of aortic dissection; however, the importance and prognostic significance of blood pressure variability (BPV) in aortic dissection are always ignored. A total of 173 acute type B aortic dissection patients were enrolled in and retrospectively reviewed between January 2009 and November 2013. There were 74 patients with high BPV and 99 with low BPV stratified by preoperative mean BPV. Technical success was achieved in all patients. The proportions of hypertension and general anesthesia were significantly higher in the high BPV group (70.3% vs 55.6% and 77% vs 62.6%, P = 0.049 and 0.043, respectively). The risk of aorta-related death in the high BPV group was apparently higher than the low BPV group (28.4% vs 9.1%, P = 0.001). By performing multivariable logistic regression, we found history of hypertension was likely to be a risk factor of BPV (95% confidence interval [CI]: 1.010-3.911), and high BPV was an independent predictor of aorta-related death (95% CI: 1.671-9.587). The difference of aorta-related mortality was pronounced between high and low BPV subgroups regardless of the refractory hypertension (41.4% vs 14.3% and 20.0% vs 7.0%, P = 0.023 and 0.037, respectively). The thrombosis ratio of false lumen was significantly higher in the low BPV group at 3-month (72.4 ± 17.5% vs 51.8 ± 11.6%, P < 0.001) and 6-month (86.4 ± 9.1% vs 69.7 ± 7.9%, P < 0.001). High BPV is an independent risk factor for the prognosis of aortic dissection. Further studies on BPV might provide new preventive and therapeutic strategies for aortic dissection.
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Affiliation(s)
- Lei Zhang
- From the Department of Vascular Surgery, Changhai Hospital, Second Military Medical University, Shanghai, China (LZ, WT, RF, CS, ZZ, JB, ZJ); Department of Pharmacology, Second Military Medical University, Shanghai, China (AL, DS); and Department of Surgery, Changhai Hospital, Second Military Medical University, Shanghai, China (JZ)
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32
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Gorla R, Erbel R, Kuehl H, Kahlert P, Tsagakis K, Jakob H, Mahabadi AA, Schlosser T, Bockisch A, Eggebrecht H, Bossone E, Jánosi RA. Prognostic value of 18F-fluorodeoxyglucose PET-CT imaging in acute aortic syndromes: comparison with serological biomarkers of inflammation. Int J Cardiovasc Imaging 2015. [DOI: 10.1007/s10554-015-0725-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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33
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Gorla R, Erbel R, Kahlert P, Tsagakis K, Jakob H, Mahabadi AA, Schlosser T, Eggebrecht H, Bossone E, Jánosi RA. Diagnostic role and prognostic implications of D-dimer in different classes of acute aortic syndromes. EUROPEAN HEART JOURNAL-ACUTE CARDIOVASCULAR CARE 2015; 6:379-388. [PMID: 26163530 DOI: 10.1177/2048872615594500] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Affiliation(s)
- Riccardo Gorla
- Department of Cardiology, West-German Heart and Vascular Center Essen and University Duisburg-Essen, Germany
- University of Insubria, Varese, Italy
| | - Raimund Erbel
- Department of Cardiology, West-German Heart and Vascular Center Essen and University Duisburg-Essen, Germany
| | - Philipp Kahlert
- Department of Cardiology, West-German Heart and Vascular Center Essen and University Duisburg-Essen, Germany
| | - Konstantinos Tsagakis
- Department of Thoracic and Cardiovascular Surgery, West-German Heart and Vascular Center Essen and University Duisburg-Essen, Germany
| | - Heinz Jakob
- Department of Thoracic and Cardiovascular Surgery, West-German Heart and Vascular Center Essen and University Duisburg-Essen, Germany
| | - Amir-Abbas Mahabadi
- Department of Cardiology, West-German Heart and Vascular Center Essen and University Duisburg-Essen, Germany
| | - Thomas Schlosser
- Department of Radiology, University Hospital Essen and University Duisburg-Essen, Germany
| | | | | | - Rolf Alexander Jánosi
- Department of Cardiology, West-German Heart and Vascular Center Essen and University Duisburg-Essen, Germany
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Jánosi RA, Gorla R, Rogmann K, Kahlert P, Tsagakis K, Dohle DS, Wendt D, Jakob H, Schlosser T, Bossone E, Erbel R. Validation of intravascular ultrasound for measurement of aortic diameters: Comparison with multi-detector computed tomography. MINIM INVASIV THER 2015; 24:289-95. [DOI: 10.3109/13645706.2015.1051053] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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35
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Dohle DS, Tsagakis K, Janosi RA, Benedik J, Kühl H, Penkova L, Stebner F, Wendt D, Jakob H. Aortic remodelling in aortic dissection after frozen elephant trunk. Eur J Cardiothorac Surg 2015; 49:111-7. [DOI: 10.1093/ejcts/ezv045] [Citation(s) in RCA: 90] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2014] [Accepted: 01/19/2015] [Indexed: 11/14/2022] Open
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36
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Kim TH, Ko YG, Kwon SW, Choi D, Lee DY, Shim WH, Hyon MS. Large False Lumen Area Is a Predictor of Failed False Lumen Volume Reduction After Stent-Graft Repair in Type B Aortic Dissection. J Endovasc Ther 2014; 21:697-706. [DOI: 10.1583/14-4671mr.1] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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37
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Silent Cerebral Ischemia After Thoracic Endovascular Aortic Repair: A Neuroimaging Study. Ann Thorac Surg 2014; 98:53-8. [DOI: 10.1016/j.athoracsur.2014.03.037] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2013] [Revised: 03/10/2014] [Accepted: 03/20/2014] [Indexed: 11/20/2022]
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38
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Aortic remodeling after endovascular treatment of complicated type B aortic dissection with the use of a composite device design. J Vasc Surg 2014; 59:1544-54. [DOI: 10.1016/j.jvs.2013.12.038] [Citation(s) in RCA: 109] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2013] [Revised: 12/12/2013] [Accepted: 12/13/2013] [Indexed: 11/17/2022]
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39
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Patterson BO, Cobb RJ, Karthikesalingam A, Holt PJ, Hinchliffe RJ, Loftus IM, Thompson MM. A systematic review of aortic remodeling after endovascular repair of type B aortic dissection: methods and outcomes. Ann Thorac Surg 2013; 97:588-95. [PMID: 24360089 DOI: 10.1016/j.athoracsur.2013.07.128] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2013] [Revised: 07/24/2013] [Accepted: 07/29/2013] [Indexed: 02/05/2023]
Abstract
BACKGROUND Endovascular treatments of Stanford type B aortic dissection may help to promote aortic remodeling and reduce the incidence of aortic-related complications. The aim of this study was to review published literature describing aortic remodeling after endovascular treatment of aortic dissection. METHODS A systematic review of the literature was performed which was compliant with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The type of aortic morphology measurements made and the methods used to make them were characterized. The endpoints of interest were the change in these measurements over time. RESULTS After initial screening, 77 articles were identified; 16 of which met the inclusion criteria. Few studies used three-dimensional reconstruction software and none had validated their measurement protocol. True lumen (TL) and false lumen (FL) diameters, areas, and in some cases volumes were measured. Studies assessed the aorta at a variety of different levels and over different periods of follow-up. Acute dissection patients displayed more consistent degree of remodeling (thoracic FL thrombosis in 80% to 90%) than chronic dissection patients (38% to 91%). Less remodeling was seen below the diaphragm in both groups. CONCLUSIONS Aortic remodeling after treatment for dissection is described in a highly heterogeneous manner. Despite this there appears to be a greater degree of complete FL resolution in patients with acute dissection than chronic. Factors such as length of aortic coverage and timing of treatment may explain the variation seen in the chronic dissection group. Consensus-based reporting standards are required to synthesize evidence and inform clinical decisions regarding patient selection and operative timing.
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Affiliation(s)
| | | | | | - Peter J Holt
- St. George's Vascular Institute, London, United Kingdom
| | | | - Ian M Loftus
- St. George's Vascular Institute, London, United Kingdom
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40
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Affiliation(s)
- Joseph E. Bavaria
- From the Division of Cardiovascular Surgery, University of Pennsylvania, Philadelphia, PA (J.E.B., W.Y.S.)
| | - Wilson Y. Szeto
- From the Division of Cardiovascular Surgery, University of Pennsylvania, Philadelphia, PA (J.E.B., W.Y.S.)
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41
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Augoustides JG, Szeto WY, Woo EY, Andritsos M, Fairman RM, Bavaria JE. The Complications of Uncomplicated Acute Type-B Dissection: The Introduction of the Penn Classification. J Cardiothorac Vasc Anesth 2012; 26:1139-44. [DOI: 10.1053/j.jvca.2012.06.024] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2012] [Indexed: 11/11/2022]
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42
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Grabenwöger M, Alfonso F, Bachet J, Bonser R, Czerny M, Eggebrecht H, Evangelista A, Fattori R, Jakob H, Lönn L, Nienaber CA, Rocchi G, Rousseau H, Thompson M, Weigang E, Erbel R. Thoracic Endovascular Aortic Repair (TEVAR) for the treatment of aortic diseases: a position statement from the European Association for Cardio-Thoracic Surgery (EACTS) and the European Society of Cardiology (ESC), in collaboration with the European Association of Percutaneous Cardiovascular Interventions (EAPCI). Eur J Cardiothorac Surg 2012; 42:17-24. [PMID: 22561652 DOI: 10.1093/ejcts/ezs107] [Citation(s) in RCA: 165] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Martin Grabenwöger
- Department of Cardiovascular Surgery, Hospital Hietzing, Vienna, Austria
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Grabenwöger M, Alfonso F, Bachet J, Bonser R, Czerny M, Eggebrecht H, Evangelista A, Fattori R, Jakob H, Lönn L, Nienaber CA, Rocchi G, Rousseau H, Thompson M, Weigang E, Erbel R. Thoracic Endovascular Aortic Repair (TEVAR) for the treatment of aortic diseases: a position statement from the European Association for Cardio-Thoracic Surgery (EACTS) and the European Society of Cardiology (ESC), in collaboration with the European Association of Percutaneous Cardiovascular Interventions (EAPCI). Eur Heart J 2012; 33:1558-63. [PMID: 22561257 DOI: 10.1093/eurheartj/ehs074] [Citation(s) in RCA: 173] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Affiliation(s)
- Martin Grabenwöger
- Department of Cardiovascular Surgery, Hospital Hietzing, Vienna, Austria
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Qing KX, Yiu WK, Cheng SW. A morphologic study of chronic type B aortic dissections and aneurysms after thoracic endovascular stent grafting. J Vasc Surg 2012; 55:1268-75; discussion 1275-6. [DOI: 10.1016/j.jvs.2011.11.099] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2011] [Revised: 11/11/2011] [Accepted: 11/15/2011] [Indexed: 11/28/2022]
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45
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Melissano G, Bertoglio L, Rinaldi E, Civilini E, Tshomba Y, Kahlberg A, Agricola E, Chiesa R. Volume changes in aortic true and false lumen after the "PETTICOAT" procedure for type B aortic dissection. J Vasc Surg 2012; 55:641-51. [PMID: 22285874 DOI: 10.1016/j.jvs.2011.10.025] [Citation(s) in RCA: 95] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2011] [Revised: 10/06/2011] [Accepted: 10/07/2011] [Indexed: 10/14/2022]
Abstract
BACKGROUND The PETTICOAT (Provisional ExTension to Induce COmplete ATtachment) technique may be employed during endovascular treatment of type B aortic dissection (TBD) using self-expandable bare stents distal to the covered stent graft placed over the proximal entry tear. The aim of this study is to evaluate the volume changes of the true (TL) and false lumen (FL) on computed tomography (CT) scans. METHODS Since 2005, 25 selected patients received endovascular treatment for complicated TBD with the PETTICOAT technique employing the Zenith Dissection Endovascular System (William Cook Europe, Bjaerverskov, Denmark). Indications to the use of the PETTICOAT technique were the evidence of clinical manifest dynamic malperfusion in five cases (20%) and/or radiologic evidence of TL collapse in 20 cases (80%). Five patients were treated within 2 weeks from onset, 13 patients between 2 weeks and 3 months, and seven patients over 3 months after the initial acute event. The volumetric analysis of the changes of TL and FL obtained from CT scan performed before endovascular treatment of TBD, postoperatively and yearly thereafter were analyzed using the OsiriX software v 3.9 (Pixmeo sarl, Bernex, Switzerland). RESULTS Initial clinical (30 days) and midterm clinical success was observed in 21 cases (84%) and in 23 cases (92%), respectively. The volumes of the aortic TL and FL were evaluated at 30 days and midterm follow-up (mean, 38 ± 17 months). The following TL volumes were recorded: baseline 84 ± 29 cm(3), postoperative 167 ± 31 cm(3) (+98%), 1 year 193 ± 46 cm(3) (+131%), and 2 years 216 ± 54 cm(3) (+140%). The following FL volumes were recorded: baseline 332 ± 86 cm(3), postoperative 286 ± 85 cm(3) (-14%), 1 year 233 ± 81 cm(3) (-30%), and 2 years 248 ± 112 cm(3) (-32%). Progressive remodeling of the TL was recorded over time in both thoracic and abdominal segments with shrinkage of the FL mainly in the thoracic segment. CONCLUSIONS These data provide insight into potential therapeutic benefit of the PETTICOAT technique. A significant immediate increase in TL could be achieved with resolution of all cases of dynamic malperfusion and TL collapse. A different behavior of volumes in the thoracic and abdominal segments was observed.
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Affiliation(s)
- Germano Melissano
- Division of Vascular Surgery, Vita - Salute University, Scientific Institute H. San Raffaele, Milan, Italy.
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46
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Distal Landing Zone Open Fenestration Facilitates Endovascular Elephant Trunk Completion and False Lumen Thrombosis. Ann Thorac Surg 2011; 92:2078-84. [DOI: 10.1016/j.athoracsur.2011.08.018] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2011] [Revised: 08/04/2011] [Accepted: 08/08/2011] [Indexed: 11/19/2022]
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47
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Nienaber CA. Influence and Critique of the INSTEAD Trial (TEVAR Versus Medical Treatment for Uncomplicated Type B Aortic Dissection). Semin Vasc Surg 2011; 24:167-71. [PMID: 22153028 DOI: 10.1053/j.semvascsurg.2011.10.003] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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48
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Zipfel B, Czerny M, Funovics M, Coppi G, Ferro C, Rousseau H, Berti S, Tealdi DG, Riambau V, Mangialardi N, Sassi C. Endovascular Treatment of Patients With Types A and B Thoracic Aortic Dissection Using Relay Thoracic Stent-Grafts: Results From the RESTORE Patient Registry. J Endovasc Ther 2011; 18:131-43. [DOI: 10.1583/10-3233mr.1] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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49
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Baek WK, Kim YS, Lim HK, Yoon YH, Kim JT, Kim KH. Aortic Arch Debranching and Antegrade Stent Graft Placement in an Expanding Distal Dissecting Aneurysm after Repair of an Acute Type I Aortic Dissection. THE KOREAN JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2010. [DOI: 10.5090/kjtcs.2010.43.6.729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Wan Ki Baek
- Department of Thoracic and Cardiovascular Surgery, Inha University Hospital
| | - Young-Sam Kim
- Department of Thoracic and Cardiovascular Surgery, Samsung Seoul Hospital, Sungkyunkwan University School of Medicine
| | | | - Yong-Han Yoon
- Department of Thoracic and Cardiovascular Surgery, Inha University Hospital
| | - Joung-Taek Kim
- Department of Thoracic and Cardiovascular Surgery, Inha University Hospital
| | - Kwang-Ho Kim
- Department of Thoracic and Cardiovascular Surgery, Inha University Hospital
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Gorlitzer M, Weiss G, Meinhart J, Waldenberger F, Thalmann M, Folkmann S, Moidl R, Grabenwoeger M. Fate of the False Lumen After Combined Surgical and Endovascular Repair Treating Stanford Type A Aortic Dissections. Ann Thorac Surg 2010; 89:794-9. [DOI: 10.1016/j.athoracsur.2009.11.054] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2009] [Revised: 11/17/2009] [Accepted: 11/19/2009] [Indexed: 11/25/2022]
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