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Li Z, Liu J, Feng R, Feng J, Li Y, Bao X, Qin F, Li T, Zhou J, Jing Z. A new porcine model of ascending aortic aneurysm established using a cover-then-cut method. Surg Today 2021; 51:906-915. [PMID: 33404782 DOI: 10.1007/s00595-020-02198-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Accepted: 09/22/2020] [Indexed: 11/28/2022]
Abstract
PURPOSE To establish a reproducible porcine model of ascending aortic aneurysm (AsAA). METHODS We created an AsAA in twelve domestic pigs using a cover-then-cut method, stitching a glutaraldehyde tanned bovine pericardial patch onto the anterolateral aortic wall, then cutting off aortic wall tissue within the patch, and closing the incision in the patch. RESULTS The AsAA creation was completed successfully in 11 out of the 12 pigs (91.7%). The mean maximal diameter of the ascending aorta increased significantly by 1.77 times, immediately after the operation (p < 0.05). Significantly continuous expansion of the aneurysm was observed during the follow up period, to 48.9 ± 1.80 mm at 3 months and 50.3 ± 2.25 mm at 6 months (p < 0.05). CONCLUSIONS This porcine model of AsAA, created using a repeatable cover-then-cut method, represents a reproducible platform for studying and training, which could contribute to the development of new feasible endovascular treatments of AsAAs.
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Affiliation(s)
- Zhenjiang Li
- Department of Vascular Surgery, Changhai Hospital, Navy Medical University, 168 Changhai Road, Shanghai, 200433, China.,Department of Vascular Surgery, The First Affiliated Hospital of the Medical School of Zhejiang University, Hangzhou, China
| | - Junjun Liu
- Department of Vascular Surgery, Changhai Hospital, Navy Medical University, 168 Changhai Road, Shanghai, 200433, China.,Department of Vascular Surgery, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Rui Feng
- Department of Vascular Surgery, Changhai Hospital, Navy Medical University, 168 Changhai Road, Shanghai, 200433, China
| | - Jiaxuan Feng
- Department of Vascular Surgery, Changhai Hospital, Navy Medical University, 168 Changhai Road, Shanghai, 200433, China.
| | - Yiming Li
- Department of Vascular Surgery, Changhai Hospital, Navy Medical University, 168 Changhai Road, Shanghai, 200433, China
| | - Xianhao Bao
- Department of Vascular Surgery, Changhai Hospital, Navy Medical University, 168 Changhai Road, Shanghai, 200433, China
| | - Feng Qin
- Department of Vascular Surgery, Changhai Hospital, Navy Medical University, 168 Changhai Road, Shanghai, 200433, China.,Department of Plastic Surgery, Peking Union Medical College Hospital, Beijing, China
| | - Tao Li
- Department of Vascular Surgery, Changhai Hospital, Navy Medical University, 168 Changhai Road, Shanghai, 200433, China
| | - Jian Zhou
- Department of Vascular Surgery, Changhai Hospital, Navy Medical University, 168 Changhai Road, Shanghai, 200433, China.
| | - Zaiping Jing
- Department of Vascular Surgery, Changhai Hospital, Navy Medical University, 168 Changhai Road, Shanghai, 200433, China.
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Valente T, Rossi G, Lassandro F, Rea G, Marino M, Muto M, Molino A, Scaglione M. MDCT evaluation of acute aortic syndrome (AAS). Br J Radiol 2016; 89:20150825. [PMID: 27033344 DOI: 10.1259/bjr.20150825] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
Non-traumatic acute thoracic aortic syndromes (AAS) describe a spectrum of life-threatening aortic pathologies with significant implications on diagnosis, therapy and management. There is a common pathway for the various manifestations of AAS that eventually leads to a breakdown of the aortic intima and media. Improvements in biology and health policy and diffusion of technology into the community resulted in an associated decrease in mortality and morbidity related to aortic therapeutic interventions. Hybrid procedures, branched and fenestrated endografts, and percutaneous aortic valves have emerged as potent and viable alternatives to traditional surgeries. In this context, current state-of-the art multidetector CT (MDCT) is actually the gold standard in the emergency setting because of its intrinsic diagnostic value. Management of acute aortic disease has changed with the increasing realization that endovascular therapies may offer distinct advantages in these situations. This article provides a summary of AAS, focusing especially on the MDCT technique, typical and atypical findings and common pitfalls of AAS, as well as recent concepts regarding the subtypes of AAS, consisting of aortic dissection, intramural haematoma, penetrating atherosclerotic ulcer and unstable aortic aneurysm or contained aortic rupture. MDCT findings will be related to pathophysiology, timing and management options to achieve a definite and timely diagnostic and therapeutic definition. In the present article, we review the aetiology, pathophysiology, clinical presentation, outcomes and therapeutic approaches to acute aortic syndromes.
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Affiliation(s)
- Tullio Valente
- 1 Department of Diagnostic Imaging, Section of General Radiology, Azienda Ospedali dei Colli, Naples, Italy
| | - Giovanni Rossi
- 1 Department of Diagnostic Imaging, Section of General Radiology, Azienda Ospedali dei Colli, Naples, Italy
| | - Francesco Lassandro
- 1 Department of Diagnostic Imaging, Section of General Radiology, Azienda Ospedali dei Colli, Naples, Italy
| | - Gaetano Rea
- 1 Department of Diagnostic Imaging, Section of General Radiology, Azienda Ospedali dei Colli, Naples, Italy
| | - Maurizio Marino
- 1 Department of Diagnostic Imaging, Section of General Radiology, Azienda Ospedali dei Colli, Naples, Italy
| | - Maurizio Muto
- 1 Department of Diagnostic Imaging, Section of General Radiology, Azienda Ospedali dei Colli, Naples, Italy
| | - Antonio Molino
- 2 Department of Pneumology, Section of Respiratory Diseases, University of Naples Federico II c/o Monaldi Hospital, Naples, Italy
| | - Mariano Scaglione
- 3 Department of Diagnostic Imaging, Presidio Ospedaliero "Pineta Grande", Caserta, Italy.,4 Department of Radiology, Darent Valley Hospital, Darfford, UK
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3
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Joseph G, Hooda A, Thomson VS. Contralateral approach to iliac artery recanalization with kissing nitinol stents present in the aortic bifurcation. Indian Heart J 2015; 67:561-4. [PMID: 26702686 DOI: 10.1016/j.ihj.2015.06.039] [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: 04/30/2015] [Revised: 06/11/2015] [Accepted: 06/29/2015] [Indexed: 10/22/2022] Open
Abstract
A 69-year-old man, who had earlier undergone reconstruction of the aortic bifurcation with kissing nitinol stents, presented with occlusion of the left external iliac artery. The occlusion was successfully and safely recanalized using contralateral femoral approach with passage of interventional hardware through the struts of the stents in the aortic bifurcation. Presence of contemporary flexible nitinol stents with open-cell design in the aortic bifurcation is not a contraindication to the use of the contralateral femoral approach.
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Affiliation(s)
- George Joseph
- Department of Cardiology, Christian Medical College, Vellore, India.
| | - Amit Hooda
- Department of Cardiology, Christian Medical College, Vellore, India
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Mokry T, Bellemann N, Sommer CM, Heussel CP, Bozorgmehr F, Gnutzmann D, Kortes NA, Kauczor HU, Radeleff B, Stampfl U. Retrospective study in 23 patients of the self-expanding sinus-XL stent for treatment of malignant superior vena cava obstruction caused by non-small cell lung cancer. J Vasc Interv Radiol 2015; 26:357-65. [PMID: 25638748 DOI: 10.1016/j.jvir.2014.11.019] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2014] [Revised: 10/17/2014] [Accepted: 11/11/2014] [Indexed: 10/24/2022] Open
Abstract
PURPOSE To evaluate retrospectively the self-expanding nitinol Sinus-XL stent (OptiMed, Ettlingen, Germany) for the treatment of superior vena cava (SVC) obstruction caused by non-small cell lung cancer (NSCLC). MATERIALS AND METHODS Between October 2009 and December 2012, 23 patients (7 women and 16 men; age, 62.5 y ± 8.5) with stage IIIA (1 patient), IIIB (4 patients) or IV (18 patients) NSCLC and acute SVC obstruction were scheduled for urgent stent implantation. The primary study endpoints were technical success (defined as accurate stent placement with complete coverage of the obstructed SVC), residual stenosis < 30%, and clinical efficacy. Complications were assessed as a secondary study endpoint. RESULTS There were 26 stents implanted in 23 patients. The technical success was 100%. Stent dilation was performed after deployment in 18 cases (78%). Stent migration into the right atrium occurred immediately after deployment in one patient; however, this stent was successfully repositioned and stabilized by a second stent. The clinical symptoms improved at least one category according to the International Consensus Committee on Chronic Venous Disease after stent implantation in all but one patient. The mean clinical follow-up was 66 days ± 83 (range, 1-305 d). Three minor complications (13%) and one major complication (4%) occurred. CONCLUSIONS Implantation of the self-expanding Sinus-XL stent for treatment of SVC obstruction caused by NSCLC is a safe and effective urgent treatment in this palliative setting.
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Affiliation(s)
- Theresa Mokry
- Department of Diagnostic and Interventional Radiology, University of Heidelberg, Im Neuenheimer Feld 110, 69120 Heidelberg, Germany.
| | - Nadine Bellemann
- Department of Diagnostic and Interventional Radiology, University of Heidelberg, Im Neuenheimer Feld 110, 69120 Heidelberg, Germany
| | - Christof M Sommer
- Department of Diagnostic and Interventional Radiology, University of Heidelberg, Im Neuenheimer Feld 110, 69120 Heidelberg, Germany
| | - Claus P Heussel
- Department of Translational Pulmonology, University of Heidelberg, Im Neuenheimer Feld 110, 69120 Heidelberg, Germany; Department of Diagnostic and Interventional Radiology, University of Heidelberg, Im Neuenheimer Feld 110, 69120 Heidelberg, Germany; Translational Lung Research Center, Member of the German Center for Lung Research, University of Heidelberg, Im Neuenheimer Feld 110, 69120 Heidelberg, Germany
| | - Farastuk Bozorgmehr
- Department of Thoracic Oncology, Thoraxlinik University of Heidelberg, Im Neuenheimer Feld 110, 69120 Heidelberg, Germany
| | - Daniel Gnutzmann
- Department of Diagnostic and Interventional Radiology, University of Heidelberg, Im Neuenheimer Feld 110, 69120 Heidelberg, Germany
| | - Nikolas A Kortes
- Department of Diagnostic and Interventional Radiology, University of Heidelberg, Im Neuenheimer Feld 110, 69120 Heidelberg, Germany
| | - Hans U Kauczor
- Department of Diagnostic and Interventional Radiology, University of Heidelberg, Im Neuenheimer Feld 110, 69120 Heidelberg, Germany; Department of Translational Pulmonology, University of Heidelberg, Im Neuenheimer Feld 110, 69120 Heidelberg, Germany; Translational Lung Research Center, Member of the German Center for Lung Research, University of Heidelberg, Im Neuenheimer Feld 110, 69120 Heidelberg, Germany
| | - Boris Radeleff
- Department of Diagnostic and Interventional Radiology, University of Heidelberg, Im Neuenheimer Feld 110, 69120 Heidelberg, Germany
| | - Ulrike Stampfl
- Department of Diagnostic and Interventional Radiology, University of Heidelberg, Im Neuenheimer Feld 110, 69120 Heidelberg, Germany
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Jánosi RA, Böse D, Konorza T, Eggebrecht H, Tsagakis K, Jakob H, Erbel R. [Malperfusion in aortic dissection: diagnostic problems and therapeutic procedures]. Herz 2012; 36:531-8. [PMID: 21858546 DOI: 10.1007/s00059-011-3498-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Malperfusion of the thoracoabdominal aorta and its side branches is a common complication of aortic dissection, often proving fatal. Vital organ malperfusion accompanying acute aortic dissection is a major cause of mortality and morbidity and requires timely reperfusion of the ischemic organs as well as adequate management of the aortic dissection. Ischemic damage to vital organs supplied by the thoracoabdominal aorta greatly increases the overall risk of aortic dissection. As initial symptoms may be subtle, malperfusion tends to be recognized late, and therefore accounts for a considerable percentage of fatalities.Effective reperfusion is not readily achieved by central aortic surgery alone in a certain number of patients. Various strategies have been used, including entry closure by central aortic surgery or stent grafting, surgical or catheter fenestration, bypass grafting and percutaneous stenting.Endovascular bare-metal stent placement is an attractive and promising treatment option since it is readily available, is less invasive and presents fewer risks to the patient.
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Affiliation(s)
- R A Jánosi
- Klinik für Kardiologie, Westdeutsches Herzzentrum Essen, Universitätsklinikum Essen, Universität Duisburg-Essen, Hufelandstr. 55, 45122, Essen, Deutschland.
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