Descending thoracic aneurysm

Elsa Madeleine Faure, Salma El Batti, Willy Sutter, Alain Bel, Pierre Julia, Paul Achouh, Jean-Marc Alsac
BACKGROUND: The treatment of complicated chronic aortic dissection remains controversial. We previously reported encouraging early results with the stent-assisted balloon-induced intimal disruption and relamination of aortic dissection (STABILISE) technique for treating complicated acute aortic dissections. However, to date there have been no specific reports on the treatment of complicated chronic aortic dissections with this technique. The aim of this study was to assess the results of the STABILISE technique to treat complicated chronic aortic dissection...
February 19, 2020: Journal of Thoracic and Cardiovascular Surgery
Giovanni Federico Torsello, Angeliki Argyriou, Konstantinos Stavroulakis, Michel J Bosiers, Martin Austermann, Giovanni B Torsello
Purpose: To report the outcomes from the observational SURPASS registry, which was created to assess the performance of the Conformable TAG (CTAG) stent-graft with the Active Control System (ACS) in patients undergoing thoracic endovascular aortic repair (TEVAR) in a real-world setting. Materials and Methods: The SURPASS registry ( ; identifier NCT03286400) was an observational, prospective, single-arm, post-market, international study that enrolled patients undergoing TEVAR using the CTAG with ACS for both acute and chronic thoracic aortic disease between October 2017 and July 2018...
March 20, 2020: Journal of Endovascular Therapy
Xu-Ran Li, Yuan-Hao Tong, Xiao-Qiang Li, Chang-Jian Liu, Chen Liu, Zhao Liu
BACKGROUND: A 46-year-old male underwent ascending aortic replacement, total arch replacement, and descending aortic stent implantation for Stanford type A aortic dissection in 2016. However, an intraoperative stent-graft was deployed in the false lumen inadvertently. This caused severe iatrogenic thoracic and abdominal aortic dissection, and the dissection involved many visceral arteries. CASE SUMMARY: The patient had pain in the chest and back for 1 mo. A computed tomography scan showed that the patient had secondary thoracic and abdominal aortic dissection...
March 6, 2020: World Journal of Clinical Cases
Cristina López Espada, Jose Patricio Linares Palomino, Jose Manuel Domínguez González, Elena Iborra Ortega Elena, Pascual Lozano Vilardell, Teresa Solanich Valldaura, Guido Volo Pérez, Estrella Blanco Cañibano, Andrés Álvarez Salgado, Juan Carlos Fernández Fernández, Manuel Hernando Rydings, Manuel Miralles Hernández
BACKGROUND: Endovascular techniques have become an essential tool for treatment of thoracic aortic pathology (TEVAR). The objetive of this study is to analyze indications and results of TEVAR in Vascular Surgery Units, through a retrospective and multicentric national registry called Regis-TEVAR. METHODS: From 2012 to 2016, a total of 287 patients from 11 Vascular Surgery Units, treated urgently and electively, were recruited consecutively. The primary variables analyzed are mortality, survival and reintervention rate...
March 13, 2020: Annals of Vascular Surgery
Marco Di Eusanio, Paolo Berretta, Mariano Cefarelli, Emanuele Gatta
Staged replacement of the aortic arch and thoraco-abdominal aorta (TAA) with a frozen elephant trunk followed by TAA repair is a valuable treatment for patients with chronic TAA dissection. However, in patients with an unclampable descending thoracic aorta, the retrieval of the trunk can be problematic and the proximal stent graft-to-graft anastomosis technically challenging. Here we present our 'double layer' frozen elephant trunk technique to treat patients with TAA dissection.
March 12, 2020: European Journal of Cardio-thoracic Surgery
Maria C Palumbo, Lisa Q Rong, Jiwon Kim, Pedram Navid, Razia Sultana, Jonathan Butcher, Alberto Redaelli, Mary J Roman, Richard B Devereux, Leonard N Girardi, Mario F L Gaudino, Jonathan W Weinsaft
INTRODUCTION: In patients with ascending aortic (AA) aneurysms, prosthetic graft replacement yields benefit but risk for complications in the descending aorta persists. Longitudinal impact of AA grafts on native descending aortic physiology is poorly understood. METHODS: Transthoracic echocardiograms (echo) in patients undergoing AA elective surgical grafting were analyzed: Descending aortic deformation indices included global circumferential strain (GCS), time to peak (TTP) strain, and fractional area change (FAC)...
2020: PloS One
Vito A Mannacio, Luigi Mannacio, Mario Monaco, Anita Antignano, Raffaele Giordano, Giovanni B Pinna, Antonino Musumeci, Gabriele Iannelli
Guidelines advice against dual antiplatelet therapy (DAPT) discontinuation less than 12 months after percutaneous coronary intervention with drug-eluting stents (DES-PCI). However, any delay of necessary surgery in patients with descending thoracic (DTA) or abdominal aortic aneurysm (AAA), treated by DES-PCI, increases the risk of aneurysm rupture/dissection. We evaluated the safety of 8-week waiting time between DES-PCI and endovascular aortic repair (EVAR). 1152 consecutive patients with coronary artery disease (CAD) needing elective DTA or AAA repair were enrolled and divided into two groups...
March 5, 2020: Updates in Surgery
Bernardo J Muñoz-Palacio, Shairine Figueroa, Gustavo Matute, Carolina Garcia-Mejía, Juan F Betancur
A hibernoma is an uncommon benign soft tissue tumor composed of brown adipose cells; the mediastinal location as presentation is scarce, with only six cases previously reported. The diagnosis of hibernoma is challenging and must be made based on the clinical, radiographic, and cytologic features. Here we present a 33-year-old woman without any relevant medical history presented for outpatient evaluation of a dry cough persisting for three months, and the X-rays revealed a dense well-defined mass with smooth borders in the left upper posterior mediastinum...
January 22, 2020: Curēus
Muhannad Aboud Abbasi, Ali Serhal, Olivia Reese, Pascale Aouad, Louise Collins, Julie Blaisdell, Jeremy Collins, James Carr
PURPOSE: To evaluate image quality and aortic dimension measurement accuracy of high resolution, motion compensated steady-state magnetic resonance angiography (SS-MRA) with a high relaxivity, extracellular fluid gadolinium-based contrast agent compared with standard first-pass contrast enhanced MRA (FP-CEMRA) in patients with thoracic aortic aneurysms. MATERIALS AND METHODS: Sixty-nine patients (mean age, 51.7 y, 25% female) diagnosed with thoracic aortic aneurysms who underwent MRA on a 1...
February 19, 2020: Journal of Thoracic Imaging
Spencer K Hansen, Javier Vasquez, Charles S Roberts
First-line therapy for aneurysm, dissection, or rupture of the descending thoracic aorta is now by the endovascular approach. Retrograde insertion of the endograft, through access from the femoral arteries, is the preferred approach. This case presents a new, innovative technique for delivery of an endoprosthesis into the descending thoracic aorta when hostile anatomy prevents delivery from the femoral arteries, iliac arteries, or infrarenal abdominal aorta in a patient not suitable for open repair.
March 2020: Journal of Vascular Surgery Cases and Innovative Techniques
Zehang Chen, Chase Brown, Fabliha Khurshan, Maximillian Kreibich, Fenton McCarthy, Joseph E Bavaria, Nimesh N Desai
BACKGROUND: Since FDA approval in 2005, TEVAR has replaced open surgery to become the preferred treatment for descending thoracic aneurysms (DTA). This study aims to investigate TEVAR trends during the previous 15 years regarding patient and hospital characteristics and their impact on survival. METHODS: Between 2000-2014, 27,079 Medicare patients underwent TEVAR for DTA. We analyzed TEVAR trends during this period and stratified hospitals based on the number of cases completed over the previous five years: low (0-19 cases), medium (20-99 cases), and high volume (≥100 cases)...
February 6, 2020: Annals of Thoracic Surgery
Sean C Wightman, Yoyo Wang, Aaron M Rohr, Christina L Greene, Gloria L Hwang, A Claire Watkins, Natalie S Lui
A 59-year-old man with a history of coarctation repair, mechanical aortic valve, and warfarin therapy presented with right flank pain. Computerized tomography (CT) scan showed a large hematoma encircling an intact descending thoracic aorta. CT angiogram demonstrated multiple areas of intercostal artery extravasation. Interventional radiology performed angiography and embolization. His course was complicated by an effusion and hypoxia; but no further bleeding was noted. We hypothesize coarctation association aneurysms and potential vessel wall weakness and as cause of hematoma in our case...
February 5, 2020: Annals of Thoracic Surgery
Karolina Engström, Farkas Vánky, Malin Rehnberg, Cecilia Trinks, Jon Jonasson, Anna Green, Cecilia Gunnarsson
BACKGROUND: Pathogenic variants in the SMAD3 gene affecting the TGF-β/SMAD3 signaling pathway with aortic vessel involvement cause Loeys-Dietz syndrome 3, also known as aneurysms-osteoarthritis syndrome. METHODS: Description of clinical history of a family in Sweden using clinical data, DNA sequencing, bioinformatics, and pedigree analysis. RESULTS: We report a novel SMAD3 variant, initially classified as a genetic variant of uncertain clinical significance (VUS), and later found to be co-segregating with aortic dissection in the family...
February 5, 2020: Molecular Genetics & Genomic Medicine
Mohammad A Zafar, Julia Fayanne Chen, Jinlin Wu, Yupeng Li, Dimitra Papanikolaou, Mohamed Abdelbaky, Thais Faggion Vinholo, John A Rizzo, Bulat A Ziganshin, Sandip K Mukherjee, John A Elefteriades
OBJECTIVES: Elucidating critical aortic diameters at which natural complications (rupture, dissection, and death) occur is of paramount importance to guide timely surgical intervention. Natural history knowledge for descending thoracic and thoracoabdominal aortic aneurysms is sparse. Our small early studies recommended repairing descending thoracic and thoracoabdominal aortic aneurysms before a critical diameter of 7.0 cm. We focus exclusively on a large number of descending thoracic and thoracoabdominal aortic aneurysms followed over time, enabling a more detailed analysis with greater granularity across aortic sizes...
November 11, 2019: Journal of Thoracic and Cardiovascular Surgery
Aamir S Shah, Akbarshakh Akhmerov, Navyash Gupta, Tarun Chakravarty, Raj R Makkar, Ali Azizzadeh
BACKGROUND: The risk of periprocedural stroke after thoracic endovascular aortic repair (TEVAR) ranges from 3% to 8%. Although cerebral embolic protection devices (CEPD) are widely utilized in transcatheter aortic valve replacement, there are currently no Food and Drug Administration approved CEPDs for use in TEVAR. We report our initial experience with the off-label use of a dual-filter CEPD in patients undergoing TEVAR. METHODS: Two patients at high risk for embolic stroke underwent TEVAR for descending thoracic aortic aneurysms (DTAAs) at a single institution...
January 22, 2020: Annals of Vascular Surgery
P Williamson, P D Docherty, S G Yazdi, M Jermy, A Khanafer, N Kabaliuk, P H Geoghegan
Cardiovascular diseases (CVD) are the leading cause of death in the developed world and aortic aneurysm is a key contributor. Aortic aneurysms typically occur in the thoracic aorta and can extend into the descending aorta. The Frozen Elephant Trunk stent (FET) is one of the leading treatments for the aneurysms extending into the descending aorta. This study focuses on the in-vitro experimentation of a stented descending aorta, investigating the haemodynamics in a compliant phantom. A silicone phantom of the descending aorta was manufactured using a lost core casting method...
July 2019: Conference Proceedings: Annual International Conference of the IEEE Engineering in Medicine and Biology Society
Viony M Belvroy, Rodrigo M Romarowski, Theodorus M J van Bakel, Joost A van Herwaarden, Jean Bismuth, Ferdinando Auricchio, Frans L Moll, Santi Trimarchi
OBJECTIVE: As elastin fibres in the aorta deteriorate with age, the descending thoracic aorta (DTA) becomes longer and more tortuous. In patients with DTA aneurysms, this increased tortuosity may result in a hostile haemodynamic environment for thoracic endovascular aortic repair (TEVAR). The objective of this study was to analyse how increased tortuosity affects haemodynamic displacement forces (DFs) in different segments of the DTA in patients with DTA aneurysms (DTAAs). METHODS: Thirty patients with DTAAs were selected to form three equal groups based on the maximum tortuosity of their DTA: low < 30°, moderate 30°-60°, and high > 60°...
January 7, 2020: European Journal of Vascular and Endovascular Surgery
Ivancarmine Gambardella, Mario F L Gaudino, Mohamad Rahouma, Woodrow J Farrington, Faiza M Khan, Irbaz Hameed, Christopher Lau, Erin Iannacone, Leonard N Girardi
OBJECTIVE: To discern the impact of depressed left ventricular ejection fraction (LVEF) on the outcomes of open descending thoracic aneurysm (DTA) and thoracoabdominal aneurysms (TAAA) repair. METHODS: Restricted cubic spline analysis was used to identify a threshold of LVEF, which corresponded to an increase in operative mortality and major adverse events (MAE: operative death, myocardial infarction, stroke, spinal cord injury, need for tracheostomy or dialysis)...
November 22, 2019: Journal of Thoracic and Cardiovascular Surgery
Viony M Belvroy, Hector W L de Beaufort, Joost A van Herwaarden, Jean Bismuth, Gabriele Piffaretti, Frans L Moll, Santi Trimarchi
OBJECTIVE: Tortuosity in the descending thoracic aorta (DTA) comes with aging and increases the risk of endoleaks after TEVAR. With this report, we would like to define and classify tortuosity in the DTA of patients with thoracic aortic disease. METHODS: Retrospective case-control study of two hundred seven patients, comparing sixty-nine controls without aortic disease (CG), to sixty-nine patients with descending thoracic aortic aneurysm (AG) and sixty-nine patients with type B aortic dissection (DG)...
December 23, 2019: World Journal of Surgery
Edin Nevzati, Jeannine Rey, Daniel Coluccia, Basil Erwin Grüter, Stefan Wanderer, Michael vonGunten, Luca Remonda, Juhana Frosen, Hans Rudolf Widmer, Javier Fandino, Serge Marbacher
BACKGROUND AND PURPOSE: Despite significant technical advances, recanalization rates after endovascular therapy of ruptured intracranial aneurysms (IAs) remain a clinical challenge. A histopathological hallmark of ruptured human IA walls is mural cell loss. Mural smooth muscle cells (SMCs) are known to promote intraluminal healing in thrombosed experimental aneurysms. In this rat model we assess the natural history and healing process after coil embolization in SMC-rich and decellularized aneurysms...
December 23, 2019: Journal of Neurointerventional Surgery
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