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chronic aortic dissection

Dorota Studzińska, Bogusław Rudel, Kamil Polok, Krzysztof Lewandowski, Krzysztof Studziński, Anna Gajdosz, Aung Oo, Michał Szczeklik, Marcin Zaczek, Maciej Zaniewski, Wojciech Szczeklik
OBJECTIVE: The aim of our study was to assess the prevalence of concomitant arterial abnormalities (true aneurysms of iliac, common femoral, renal, visceral arteries and stenoses of iliac and renal arteries) in patients with abdominal aortic aneurysm, and to evaluate whether the type of the aneurysm (suprarenal versus solely infrarenal) is associated with this prevalence. METHODS: In this retrospective cross-sectional study we assessed computed tomography angiography scans of 933 patients with abdominal aortic aneurysm, including thoraco-abdominal aortic aneurysms type II-IV, with no history of abdominal aortic surgery...
February 2, 2019: Annals of Vascular Surgery
Daniel-Sebastian Dohle, Hazem El Beyrouti, Lena Brendel, Philipp Pfeiffer, Mohammed El-Mehsen, Christian-Friedrich Vahl
OBJECTIVES: Conventional treatment for acute type A dissection is the replacement of the ascending aorta. This study demonstrates the results of a conventional approach with isolated proximal repair combined with concomitant endovascular procedures. METHODS: Replacement of the ascending aorta with or without an open distal anastomosis was defined as isolated proximal repair and was performed in 562/588 patients between January 2004 and June 2017. A total of 68% were DeBakey type I and 32% were DeBakey type II aortic dissections...
February 2, 2019: Interactive Cardiovascular and Thoracic Surgery
David J Tobey, Tyler S Reynolds, George E Kopchok, Carlos E Donayre, Ali Khoynezhad, Rodney A White
INTRODUCTION: Dynamic compliance (Cd) of the adult thoracic ascending and arch aorta has had limited evaluation in vivo in patients with aortic disease. This study evaluates aortic compliance using intravascular ultrasound (IVUS) across a range of thoracic aortic diseases. METHODS: Seventy-nine patients undergoing thoracic aortic endovascular procedures had Cd measurements of the ascending aorta proximal to the origin of the brachiocephalic trunk and distal to the origin of the left common carotid artery using IVUS prior to endograft deployment...
January 30, 2019: Annals of Vascular Surgery
Justine Mafalda Ravaux, Philippe Remy, Marc Detroux, Francesco Torella, Charles Swaelens
We present the off-label use of a ThoraflexTM Hybrid Plexus Prosthesis (Vascutek, Scotland, UK) to treat a post-dissection type IV thoraco-abdominal aortic aneurysm (TAA) in a high-risk patient previously treated with a thoracic stent-graft for a chronic type B aortic dissection. The Thoraflex graft was used in a "reversed frozen elephant trunk" fashion: the stent graft portion deployed in the previously placed thoracic stent, and the branched portion used to revascularize visceral arteries and lower limbs...
January 28, 2019: Annals of Thoracic Surgery
Fiona Rohlffs, Nikolaos Tsilimparis, John Mogensen, Vladimir Makaloski, Sebastian Debus, Tilo Kölbel
PURPOSE: To introduce the new generation Candy-Plug II with a self-closing channel construction inside the plug. TECHNIQUE: The technique of the Candy-Plug II was demonstrated in a 50 year-old patient with residual chronic aortic dissection and thoracic false lumen aneurysm with false lumen back-flow following open surgical repair of the ascending aorta for acute Type A aortic dissection. The Candy-Plug technique was applied in addition to a branched arch procedure using a new generation Candy-Plug II for false lumen occlusion...
January 25, 2019: Annals of Vascular Surgery
ZiMian Gao, Kaiyi Zhao, Hao Pan, Kui Chen, JiHang Zheng
PURPOSE: Spinal cord ischemia is a rare complication of endovascular repair of abdominal aortic aneurysm (AAA) that is attributed to the variable anatomy of the artery of Adamkiewicz, embolization of the collateral circulation, or hypoperfusion of cord structures secondary to hypotension. CASE REPORT: A hypertensive 83-year-old male with chronic obstructive pulmonary disease presented with a 2.3 cm right iliac artery dissecting aneurysm. Paraplegia occurred on the first day after endovascular repair of iliac artery aneurysm...
January 23, 2019: Annals of Vascular Surgery
Vicenç Riambau, Rocco Giudice, Piero Trabattoni, Secundino Llagostera, Gianfranco Fadda, Massimo Lenti, Iván García, Jordi Maeso, Carla Blanco, Fabio Verzini
PURPOSE: To evaluate the early safety and clinical performance of the new low-profile RelayPro Thoracic Stent-Graft System in patients with thoracic aortic disease. METHODS: This was an international, prospective, single-arm study in patients diagnosed with thoracic aorta disease (aneurysm, pseudoaneurysm, dissection, penetrating aortic ulcer [PAU], or intramural hematoma) and treated with a RelayPro stent-graft (in bare stent and/or non-bare stent configurations)...
January 23, 2019: Annals of Vascular Surgery
Matteo Orrico, Sonia Ronchey, Carlo Setacci, Mario Marino, Alessio Vona, Antonio Lorido, Fabrizio Nesi, Alessia Giaquinta, Nicola Mangialardi
OBJECTIVE: To report the Destino guided BEVAR (De-BEVAR) approach as a valid alternative to catheterization downward branches in complex aortic arch/descending thoracic anatomies. TECHNIQUE & CASE REPORT: A 53 years-old woman with Marfan syndrome underwent a TAAA repair for a type III dissecting aneurysm. A custom repair with an endograft having 3 fenestrations (for renal arteries and superior mesenteric artery) and one branch for the celiac trunk was planned...
January 23, 2019: Annals of Vascular Surgery
Cali E Johnson, Sung W Ham, Kenneth R Ziegler, Gregory A Magee, Fred A Weaver, Fernando Fleischman, Sukgu M Han
Chronic type B aortic dissections with continued aneurysmal expansion of the thoracoabdominal aorta after the initial thoracic endovascular aortic repair represent a subset of aortic pathology in which staged distal extension to seal additional septal tears can be advantageous. This approach may require incorporation of visceral or renal branches into the distal seal zone, while maintaining the possibility of further distal extension in the future. We describe a novel technique for incorporation of the celiac axis, with a branch stent graft delivered from a transfemoral approach, then lifted cranially to create an antegrade sandwich graft configuration in a 59-year-old male who presented with a complicated type B aortic dissection requiring coverage of the celiac artery...
January 23, 2019: Annals of Vascular Surgery
Ke Xu, Wei Sun, Zhenya Dong, Haiying Xing, Yining Huang
We report the case of a patient with chronic type A aortic dissection (AD), who had been admitted, 18 months ago, to another hospital with acute chest-tearing pain accompanied with transient loss of consciousness. His symptoms resolved but he reported after discharge a toothache and fluctuating right mandibular pain. He presented to our outpatient clinic because his facial pain aggravated. Physical examination demonstrated a bruit over the right carotid artery. Transthoracic echocardiography and carotid sonography demonstrated aortic dissection extending into the extracranial right internal carotid artery (ICA), which was tortuous...
January 23, 2019: Journal of Clinical Ultrasound: JCU
Michalina Krych, Joanna Ponińska, Zofia T Bilińska, Rafał Płoski, Elżbieta K Biernacka
We report on a 44-year-old woman with coincidence of two genetic disorders: Andersen-Tawil syndrome and Marfan syndrome. In both, life-threatening arrhythmias could occur. A 44-year-old woman presented acute ascending aortic dissection with aortic arch involvement and chronic thoracic descending and abdominal aortic dissection. Clinical and genetic examination confirmed Marfan syndrome (MFS) diagnosis. Due to repolarization disorder in ECG and premature ventricular contractions in Holter ECG, the sequencing data were analyzed again and mutation in KCNJ2 gene was identified...
January 23, 2019: Annals of Noninvasive Electrocardiology
Ken Nakamura, Tetsuro Uchida, Ri Sho, Azumi Hamasaki, Jun Hayashi, Mitsuaki Sadahiro
Objectives : Uncomplicated type B aortic dissection is generally treated with medical management including antihypertensive therapy. The purpose of this study is to investigate risk factors associated with the aortic enlargement in medically treated patients. Methods : Between July 2004 and April 2016, 127 consecutive patients with acute type B aortic dissection were treated in our institution. Of these, 104 patients diagnosed with uncomplicated type B dissection were managed medically as an initial treatment...
December 25, 2018: Annals of Vascular Diseases
Tetsuro Uchida, Mitsuaki Sadahiro
Thoracic endovascular aortic repair (TEVAR) for thoracic aortic disease constitutes a paradigm shift in the treatment strategy of aortic dissection, as well as thoracic aortic aneurysms. Conventionally, most patients with Stanford type B acute aortic dissection are treated using conservative medical treatment during the acute phase. However, in patients with complicated type B aortic dissection who present with life-threatening complications, TEVAR has been introduced as a novel and less-invasive alternative and has shown better early results than those observed with conventional therapy...
December 25, 2018: Annals of Vascular Diseases
Yu Chen, Wei-Guo Ma, Ai-Hua Zhi, Lingeng Lu, Jun Zheng, Wei Zhang, Yong-Min Liu, Jun-Ming Zhu, John A Elefteriades, Li-Zhong Sun
OBJECTIVE: The use of the frozen elephant trunk technique for type A aortic dissection in Marfan syndrome is limited by the lack of imaging evidence for long-term aortic remodeling. We seek to evaluate the changes of the distal aorta and late outcomes after frozen elephant trunk and total arch replacement for type A aortic dissection in patients with Marfan syndrome. METHODS: Between 2003 and 2015, we performed frozen elephant trunk + total arch replacement for 172 patients with Marfan syndrome suffering from type A aortic dissection (94 acute; 78 chronic)...
August 24, 2018: Journal of Thoracic and Cardiovascular Surgery
Ludovic Canaud, Thomas Gandet, Julien Sfeir, Baris Ata Ozdemir, Laurence Solovei, Pierre Alric
OBJECTIVE: A review of the literature was conducted for incidence, outcomes, and risk factors for distal stent graft-induced new entry (SINE) after thoracic endovascular aortic repair (TEVAR) of aortic dissection. METHODS: The review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. RESULTS: Seven articles reporting on 1415 patients with thoracic aortic dissection undergoing TEVAR without supplemental distal bare stenting were included...
January 3, 2019: Journal of Vascular Surgery
Fernando Motta, Jason R Crowner, Corey A Kalbaugh, William A Marston, Luigi Pascarella, Katharine L McGinigle, Melina R Kibbe, Mark A Farber
OBJECTIVE: To report the outcomes of patients enrolled in a physician-sponsored investigational device exemption trial for endovascular treatment of complex thoracoabdominal aortic aneurysms with fenestrated and/or branched devices. METHODS: This study represents a retrospective analysis of a prospectively maintained database of patients enrolled in a physician-sponsored investigational device exemption trial for endovascular treatment of complex thoracoabdominal aneurysms between July 2012 and July 2017...
December 24, 2018: Journal of Vascular Surgery
Wan Kee Kim, Sung Jun Park, Ho Jin Kim, Hee Jung Kim, Suk Jung Choo, Joon Bum Kim
OBJECTIVES: The current guidelines do not consider chronic type A aortic dissection as one of the triggers for prophylactic aortic repair, and an aortic diameter of 55 mm is considered the threshold for surgery. METHODS: From the institutional database, we retrieved 82 patients who were diagnosed as having chronic type A aortic dissection but did not undergo immediate surgical repair from 1997 to 2016. The primary outcome was a composite of adverse aortic events defined as aortic rupture and sudden death...
November 17, 2018: Journal of Thoracic and Cardiovascular Surgery
Masato Furui, Shoji Sakaguchi, Bunpachi Kakii, Gaku Uchino, Mai Asanuma, Hiroaki Nishioka, Takeshi Yoshida
OBJECTIVES: Patients with chronic aortic dissection often require repeat interventions due to enlargement of the pressurized false lumen or disseminated intravascular coagulation even after additional thoracic endovascular aortic repair (TEVAR) to occlude the entry tear. Residual false lumen flow can persist even after performing the candy-plug technique or branched stent-graft placement in some cases. We have devised a new method for false lumen closure. METHODS: From December 2010 to May 2017, 5 patients (mean age: 57 [13] years, range: 43-77 years) with chronic dissection at the aortic arch and descending aorta, who underwent initial TEVAR, required additional treatment...
December 17, 2018: Vascular and Endovascular Surgery
Mel J Sharafuddin, Jay K Bhama, Mohammad Bashir, Maen S Aboul-Hosn, Jeanette H Man, Alexandra J Sharp
BACKGROUND: The general goals of endovascular management in chronic distal thoracic aortic dissection are optimizing the true lumen, maintaining branch patency, and promoting false lumen (FL) thrombosis. Distal seal can be challenging in chronic distal thoracic aortic dissection due to the well-established secondary fenestrations and fibrotic septum. We describe our approach of distal landing zone optimization (DLZO) to enable full-diameter contact of the distal endoprosthesis. MATERIALS AND METHODS: Our experience includes 19 procedures in 16 patients (12 male, age 68 ± 8 years) between May 2014 and November 2017...
January 2019: Journal of Thoracic and Cardiovascular Surgery
Yuki Ikeno, Koki Yokawa, Takashi Matsueda, Katsuhiro Yamanaka, Takeshi Inoue, Hiroshi Tanaka, Yutaka Okita
OBJECTIVE: Our study evaluated the long-term outcomes of total arch replacement using a 4-branched graft. METHODS: From October 1999 to December 2016, 655 patients underwent total arch replacement using a 4-branched graft (pathology in the 655 patients was distributed as 399 no dissection, 149 acute dissection, and 107 chronic dissection). Two hundred nine patients (31.9%) underwent nonelective surgery. Mean follow-up term was 5.0 ± 4.1 years and follow-up rate was 97...
January 2019: Journal of Thoracic and Cardiovascular Surgery
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