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chronic aortic dissection

Ahmed Sameh Eleshra, Woon Heo, Kwang-Hun Lee, Shin-Young Lee, Ha Lee, Suk-Won Song
We report a case of acute type I aortic dissection in which an emergency graft replacement of the ascending aorta and innominate artery was performed. We performed false lumen thrombosis through hybrid thoracic endovascular aortic repair to seal the primary entry tear, followed by false lumen obliteration at the level of the descending thoracic aorta, abdominal aorta, and right common iliac artery. Over a period of 4.5 years, we used Amplatzer vascular plugs and coils based on our computed tomography angiography follow-up protocol...
August 2018: Korean Journal of Thoracic and Cardiovascular Surgery
Grayson H Wheatley
No abstract text is available yet for this article.
July 20, 2018: Journal of Thoracic and Cardiovascular Surgery
Paul P Urbanski, Vadim Irimie, Aristidis Lenos, Petros Bougioukakis, Alaa Atieh, Lukas Lehmkuhl
OBJECTIVES: The aim of the study was to evaluate the incidences of innominate artery (IA) involvement in aortic arch pathology necessitating surgery, the surgical strategies and the operative results. METHODS: Among the 366 patients who underwent total/subtotal arch replacement because of non-acutely dissected aortic pathology between 2004 and June 2017, there were 46 (12.6%) patients (29 males; mean age 69 ± 10, range 35-84 years) with IA involvement. Pathologies necessitating replacement of the IA were chronic aneurysm including progression of chronic dissection, severe atherosclerosis with or without an aneurysmatic dilatation, and inflammatory vasculitis in 34, 11 and 1 patient, respectively...
August 6, 2018: European Journal of Cardio-thoracic Surgery
Jae Hyun Kim, Kyung Sub Song, Jae Bum Kim
Endovascular aortic treatment is being performed more often and offers some advantages over open surgery. Nevertheless, open repair of thoracoabdominal aortic aneurysms is still relevant in complex cases, including combined chronic aortic dissection, congenital aortic abnormalities such as aberrant right subclavian artery, and dense pleural adhesions after a previous thoracotomy. We describe our successful use of open repair in a 46-year-old man who had these multiple abnormalities.
June 2018: Texas Heart Institute Journal
Yuji Kanaoka, Takao Ohki, Koji Kurosawa, Koji Maeda, Kota Shukuzawa, Masayuki Hara, Takeshi Baba, Reo Takizawa, Hiromasa Tachihara
BACKGROUND: The aim of this study was to evaluate endovascular treatment for enlarged Stanford type B chronic aneurysmal aortic dissection (CAAD). The conventional treatment for CAAD is open repair; however, the operative mortality is high in extensive prosthetic graft replacements. METHODS: A retrospective single-center study was conducted on 74 consecutive patients who underwent endovascular treatment for CAAD in the past 8.5 years. In the partial exclusion (PE) group, entry sites in close proximity to the maximum diameter of CAAD were closed using a stent graft and reentry sites were left without closure...
August 2, 2018: Therapeutic Advances in Cardiovascular Disease
Tao Ma, Zhi Hui Dong, Shengzhang Wang, Zhuang Yuan Meng, Yin Yin Chen, Wei Guo Fu
OBJECTIVE: Retrograde type A dissection (RTAD) after thoracic endovascular aortic repair (TEVAR) has been a major drawback of endovascular treatment. To our knowledge, no studies have evaluated aortic injuries caused by stent grafts (SGs). Therefore, the aim of this study was to evaluate and to quantify the SG-aorta interaction and to analyze the risk factors for injury through computational simulation. METHODS: The aortic geometry was extracted from an RTAD case...
July 28, 2018: Journal of Vascular Surgery
Marius Ante, Spyridon Mylonas, Denis Skrypnik, Moritz S Bischoff, Fabian Rengier, Jan Brunkwall, Dittmar Böckler
OBJECTIVE/BACKGROUND: The aim was to analyse the prevalence of computed tomographic (CT) morphological predictors and their influence on early chronic phase aortic diameter expansion in patients with uncomplicated acute Stanford type B aortic dissection (ATBAD). METHODS: This retrospective analysis reviewed the CT imaging of 140 patients admitted with uncomplicated ATBAD to two tertiary centres between March 2003 and April 2016. The prevalence of the following CT-morphological predictors was determined at baseline: primary entry tear (PET) diameter ≥ 10 mm, its location at the concavity of the aortic arch; maximum descending aortic diameter ≥ 40 mm; false lumen (FL) diameter ≥ 22 mm; partial FL thrombosis and a fusiform index (FI) of ≥0...
July 26, 2018: European Journal of Vascular and Endovascular Surgery
Claudia Menichini, Selene Pirola, Baolei Guo, Weiguo Fu, Zhihui Dong, Xiao Yun Xu
PURPOSE: To explore the potential role of morphological factors and wall stress in the formation of stent-graft-induced new entries (SINE) based on computed tomography (CT) images after thoracic endovascular aortic repair (TEVAR). CASE REPORT: Two female patients aged 59 years (patient 1) and 44 years (patient 2) underwent TEVAR for type B dissection in the chronic (patient 1) or subacute (patient 2) phase. CT scans at 3-month follow-up showed varying degrees of false lumen thrombosis in both patients...
July 30, 2018: Journal of Endovascular Therapy
Sabreen Mkalaluh, Marcin Szczechowicz, Bashar Dib, Alexander Weymann, Gabor Szabo, Matthias Karck
OBJECTIVE: Open surgical repair of thoracoabdominal aortic aneurysm remains an important treatment option and continues to be challenging. The objective of this study was to investigate the results after open repair of thoracoabdominal aortic aneurysms in a contemporary non-high-volume center collective. METHODS: A total of 38 patients underwent operation for thoracoabdominal aortic aneurysm between August 2007 and April 2017. Patients had aortic aneurysm and chronic aortic dissection...
June 6, 2018: Journal of Thoracic and Cardiovascular Surgery
Masami Shingaki, Kiyofumi Morishita, Toshio Baba, Tsuyoshi Shibata, Kohei Narayama
PURPOSE: Often, we experience cases of aneurysm shrinkage and no aneurysm shrinkage after successful endovascular aortic aneurysm repair (EVAR), without postoperative endoleaks. We studied these cases to ascertain the predictive factors for aneurysm shrinkage. METHODS: From 2007 to 2014, we selected 255 cases that comprised aneurysm shrinkage (> 4 mm) and no-shrinkage cases (shrinkage from 0 to 4 mm). Excluding 36 cases of endoleaks, 43 cases without one-year follow-up CT scan, and 3 cases of aortic dissection, we assessed 93 cases of aneurysm shrinkage (S group) and 80 cases of no aneurysm shrinkage (N group) at one-year follow-up...
July 13, 2018: Annals of Vascular Surgery
Arunesh Majumder, Rajesh B Dharmaraj
Introduction: Aorto-oesophageal fistula is a rare but life threatening cause of upper gastrointestinal haemorrhage. Severity of presentation and complexity of subsequent management depends on the size of the defect on both the aortic side and oesophagus. Report: The patient was a 67 year old Chinese man, who presented initially with a Stanford type A dissection with caudal extension to the right common iliac artery. The patient underwent replacement of the ascending aorta and proximal arch with debranching of the right innominate artery and aortic valve replacement...
2018: EJVES Short Reports
Karl Sörelius, Anders Wanhainen
Introduction: Despite weak evidence, current treatment guidelines for uncomplicated acute type B aortic dissection (uATBAD) consistently recommend intensive and rapid lowering of systolic blood pressure and heart rate. Report: The case of a 62 year old man with uATBAD, who was treated according to guidelines, is presented. Owing to an unknown chronic occlusion of the left carotid artery combined with intensive hypotensive treatment, the patient developed a cerebral infarct...
2018: EJVES Short Reports
Katrien Van Kolen, Jerrold Spapen, Marc Vaerenberg
No abstract text is available yet for this article.
July 5, 2018: Acta Cardiologica
Patrick R Vargo, Christopher J Smolock, Robert J Steffen, Federico E Parodi, Edward G Soltesz
A patient with residual thoracoabdominal aortic aneurysm and chronic dissection extending into the branch iliac arteries underwent staged open and endovascular repair. Open repair of the reno-visceral segment was performed with an "elephant trunk" trunk graft placed distally into a 12-cm infra-renal aorta. One month later, the patient underwent a successful completion endovascular aortic repair. This case demonstrates the utility of combining traditional and endovascular surgery to manage complex aortic pathologies...
July 1, 2018: Journal of Cardiac Surgery
Daniel Runggaldier, Taro Minami, Daniel Golding, Kamran Manzoor
A 54-year-old man with history of chronic obstructive pulmonary disease (COPD) presented with subacute onset of chest pain, shortness of breath, productive cough with haemoptysis and night sweats. There were no fever or recent weight loss reported. The chest radiograph showed right upper lobe bullae with adjacent opacification and an emphysematous lung. Due to worsening haemoptysis and persistent chest pain, CT of the chest with contrast was performed, which revealed moderate to severe emphysema and numerous blood-filled bullae...
June 28, 2018: BMJ Case Reports
Rika Yoshida, Takeshi Yoshizako, Minako Maruyama, Yoshikazu Takinami, Yoshihide Shimojo, Yukihisa Tamaki, Hajime Kitagaki
Background Spontaneous superior mesenteric artery (SMA) dissection is rare cause of acute abdomen. Time-dependent change of SMA dissection has not been established. Purpose To determine Sakamoto classification (SC) type of acute and chronic SMA dissection (aSMAD and cSMAD) to predict the treatment methods and outcome. Material and Methods From April 2003 to March 2017, unenhanced and contrast-enhanced CT were used to diagnose acute symptomatic or chronic asymptomatic SMA dissection in 25 consecutive patients without aortic dissection...
January 1, 2018: Acta Radiologica
Nikolaos A Papakonstantinou, Vasileios Patris, Constantine N Antonopoulos, Ilias Samiotis, Mihalis Argiriou
There are few cases in the literature reporting dysphagia caused by oesophageal compression by the aorta due to acute or chronic aortic pathology. This type of dysphagia is called dysphagia aortica. Thoracic endovascular aortic repair is nowadays the treatment of choice for anatomically suitable patients experiencing complicated Type B aortic dissection. Oesophageal necrosis is a rare but fatal complication following thoracic endovascular aortic repair. Extrinsic oesophageal compression by the thrombosed aneurysmal sac, a mediastinal haematoma or extensive thrombosis in the false lumen of a dissected aorta and acute vascular occlusion of the oesophageal supply are possible mechanisms...
June 25, 2018: Interactive Cardiovascular and Thoracic Surgery
Roland Assi, Joseph E Bavaria, Nimesh Desai
Despite successful repair of acute type A aortic dissection (TAAD), the distal false lumen may remain patent resulting in progressive degeneration of the remaining distal aorta. This can lead to aneurysmal dilatation and risk of rupture. Open distal reoperation to replace the residually dissected thoraco-abdominal aorta may be accomplished with acceptable morbidity and mortality in experienced hands. This can be facilitated when the index operation for acute TAAD is tailored to exclude all primary tears and set the arch and descending aorta for a subsequent open, endovascular or hybrid procedure...
June 26, 2018: Journal of Cardiovascular Surgery
Fiona Rohlffs, Konstantinos Spanos, Nikolaos Tsilimparis, Eike S Debus, Tilo Kölbel
Endovascular strategies have been increasingly used for the treatment of chronic type B aortic dissection (cTBAD) offering better outcomes in terms of mortality and morbidity compared to open surgical repair. 1, 2 Aortic remodeling after standard TEVAR is less likely in cTBAD due to rigidity of the dissection membrane.3 Another limition of endovascular therapy is continued retrograde false lumen perfusion with back-flow from distal entry tears.4 Treatment strategies in cTBAD should aim at false lumen thrombosis...
June 26, 2018: Journal of Cardiovascular Surgery
Ludovic Canaud, Bernard Albat, Kheira Hireche, Aurelien Hostalrich, Pierre Alric, Thomas Gandet
A 79-year-old woman was admitted with a large chronic dissecting ascending aortic aneurysm starting 5 mm distal to the ostia of the left coronary artery and ending immediately proximal to the innominate artery. A reverse extra-anatomic aortic arch debranching procedure was performed. During the same operative time, through a transapical approach, a thoracic stent graft was deployed with the proximal landing zone just distal to the coronary ostia and the distal landing zone excluding the origin of the left common carotid artery...
June 2018: Journal of Vascular Surgery Cases and Innovative Techniques
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