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chronic aortic dissection

Tetsuo Shoji, Masaaki Inaba, Masafumi Fukagawa, Ryoichi Ando, Masanori Emoto, Hisako Fujii, Akira Fujimori, Mitsuru Fukui, Hiroki Hase, Tetsuya Hashimoto, Hideki Hirakata, Hirokazu Honda, Tatsuo Hosoya, Yuji Ikari, Daijo Inaguma, Toru Inoue, Yoshitaka Isaka, Kunitoshi Iseki, Eiji Ishimura, Noritomo Itami, Chiharu Ito, Toshitaka Kakuta, Toru Kawai, Hideki Kawanishi, Shuzo Kobayashi, Junko Kumagai, Kiyoshi Maekawa, Ikuto Masakane, Jun Minakuchi, Koji Mitsuiki, Takashi Mizuguchi, Satoshi Morimoto, Toyoaki Murohara, Tatsuya Nakatani, Shigeo Negi, Shinichi Nishi, Mitsushige Nishikawa, Tetsuya Ogawa, Kazumichi Ohta, Takayasu Ohtake, Mikio Okamura, Senji Okuno, Takashi Shigematsu, Toshitsugu Sugimoto, Masashi Suzuki, Hideki Tahara, Yoshiaki Takemoto, Kenji Tanaka, Yoshihiro Tominaga, Yoshiharu Tsubakihara, Yoshihiro Tsujimoto, Kazuhiko Tsuruya, Shinichiro Ueda, Yuzo Watanabe, Kunihiro Yamagata, Tomoyuki Yamakawa, Shozo Yano, Keitaro Yokoyama, Noriaki Yorioka, Minoru Yoshiyama, Yoshiki Nishizawa
Importance: Patients with chronic kidney disease have impaired vitamin D activation and elevated cardiovascular risk. Observational studies in patients treated with hemodialysis showed that the use of active vitamin D sterols was associated with lower risk of all-cause mortality, regardless of parathyroid hormone levels. Objective: To determine whether vitamin D receptor activators reduce cardiovascular events and mortality in patients without secondary hyperparathyroidism undergoing hemodialysis...
December 11, 2018: JAMA: the Journal of the American Medical Association
Tsuyoshi Yoshimuta, Akira Tsuneto, Toshiya Okajima, Hiroshi Tanaka, Takako Minami, Masakazu Yamagishi, Satoshi Ikeda, Hiroaki Kawano, Koji Maemura
Leg malperfusion caused by dynamic obstruction is a serious complication of aortic dissection. A diagnosis of the malperfusion is difficult because it is made mainly on the basis of nonspecific symptoms such as intermittent claudication and numbness on walking. In the present study, we reported on a case of a 51-year-old man with leg malperfusion in chronic aortic dissection diagnosed by Doppler ultrasound. The combination of bisferious and dampened velocity waveform changes after walking may lead us to suspect a leg malperfusion caused by dynamic obstruction...
December 1, 2018: Echocardiography
Chun-Yu Lin, I-Hao Su, Sung-Yu Chu, Po-Jen Ko
Despite recent advances in surgical techniques and endovascular devices, the management of ruptured type B aortic dissection remains challenging. Herein, we describe a patient with a history of chronic type B aortic dissection who presented to the emergency department with a massive left hemothorax and profound shock. Computed tomography demonstrated a thoracic dissecting aneurysm with false-lumen rupture. He underwent emergent thoracic endovascular aortic repair and carotid-carotid crossover bypass in a hybrid operating room...
November 27, 2018: Annals of Vascular Surgery
Dolly Thakkar, Michael D Dake
Aortic dissection is one of the most catastrophic vascular challenges faced by interventionalists, often misdiagnosed and frequently associated with devastating consequences. Stanford type B aortic dissections affects the descending thoracic aorta without any involvement of the ascending aorta. Dissections associated with refractory pain, rapid aneurysm formation, malperfusion syndromes, rupture, or impending rupture are categorized as complicated and distinct from initially uncomplicated type B dissections without the aforementioned complications...
September 2018: Techniques in Vascular and Interventional Radiology
Konstantinos Spanos, Tilo Kölbel, Fiona Rohlffs, Franziska Heidemann, Athanasios D Giannoukas, Sebastian E Debus, Nikolaos Tsilimparis
BACKGROUND: Residual patent false lumen (FL) after chronic type B (cTBAD) or type A aortic dissection (TAAD) treatment is independently associated with poor long-term outcome. The aim of our study was to present endovascular techniques and the existing experience of targeted false lumen (FL) thrombosis after cTBAD or type A TAAD treatment. MATERIAL AND METHODS: A systematic review was performed (PRISMA) searching in MEDLINE, CENTRAL, and Cochrane databases including studies reporting on targeted FL occlusion after cTBAD or TAAD...
November 26, 2018: Annals of Vascular Surgery
Sophie Tkebuchava, Raphael Tasar, Thomas Lehmann, Gloria Faerber, Mahmoud Diab, Martin Breuer, Ulrich Franke, Hristo Kirov, Jan Gummert, Artur Lichtenberg, Thorsten Wahlers, Torsten Doenst
INTRODUCTION:  Aortic valve reimplantation is considered technically demanding. We searched for predictors of long-term outcome including the surgeon as risk factor. METHODS:  We selected all aortic valve reimplantations performed in our department between December 1999 and January 2017 and obtained a complete follow-up. The main indications were combined aortic aneurysm plus aortic valve regurgitation (AR), 69% and aortic dissections (15%). In 14%, valves were bicuspid...
November 28, 2018: Thoracic and Cardiovascular Surgeon
Mourad Boufi, Benjamin O Patterson, Anderson D Loundou, Laurent Boyer, Matthew Joe Grima, Ian M Loftus, Peter J Holt
BACKGROUND: The respective place of endovascular versus open surgery in thoracic dissecting aneurysm treatment remains debatable. This comprehensive review seeks to analyse the outcomes of endovascular repair (ER) compared to open surgery (OS) in chronic type B aortic dissection treatment. METHODS: Embase and Medline searches (2000 - 2017)were performed following Preferred Reporting Items for Systematic Review and Meta-Analyses guidelines. Outcomes data extracted comprised firstly early mortality and major complications: stroke, spinal cord ischemia (SCI), dialysis, respiratory complications; secondly, late survival and reinterventions...
November 24, 2018: Annals of Thoracic Surgery
Sherif Sultan, Edel P Kavanagh, Dave Veerasingam, Victor Costache, Ala Elhelali, Brian Fitzgibbon, Edward Diethrich, Niamh Hynes
OBJECTIVE: The aim was to expand our understanding of the dynamic evolution of the aorta throughout the dissection time course. We investigated how the disease process can be modulated to equalise lumen pressure, enhance perfusion, and stabilise the aorta along its entire length using the kinetic elephant trunk (kET) technique. TECHNIQUE: We performed the kET on nine patients with chronic symptomatic aortic dissection (CSAD) as a primary or secondary intervention regardless of the chronicity of the dissection...
November 23, 2018: Annals of Vascular Surgery
Myriam Johanna Schafigh, Zaki Kohistani, Wolfgang Schiller, Chris Probst
A patient with progressive chronic type B dissection and contraindication for open surgery underwent thoracic endovascular aortic repair using a Cardiatis Multilayer Flow Modulator®. Two weeks after the intervention, the patient experienced a ruptured retrograde type A aortic dissection caused by the stent's uncovered proximal ends.
November 22, 2018: Interactive Cardiovascular and Thoracic Surgery
Snjezana Janjetovic, Katharina Holstein, Christina Dicke, Carsten Bokemeyer, Florian Langer
Characteristic features of disseminated intravascular coagulation (DIC) are the opposing risks of bleeding (due to consumptive coagulopathy and hyperfibrinolysis) and organ failure (due to widespread microvascular thromboses). The purpose of anticoagulation in DIC is to attenuate excessive thrombin generation and fibrin deposition. While heparins have been shown to be beneficial in this context, the safety and efficacy of direct oral anticoagulants have not yet been sufficiently addressed. Here, we report two patients in whom chronic DIC was stabilized upon administration of apixaban: an elderly male with aortic dissection presenting with significant mucocutaneous bleeding and a younger female with Klippel-Trénaunay-Weber syndrome presenting with multiple superficial vein thromboses (SVTs)...
November 19, 2018: Hämostaseologie
Takuya Fujikawa, Shin Yamamoto, Susumu Oshima, Kensuke Ozaki, Junichi Shimamura, Hiroaki Asada, Randolph H L Wong
BACKGROUND: Thoracic endovascular aortic repair has become the preferred treatment for a variety of descending thoracic aortic pathologies. However, there are unresolved issues such as morphologic appearance of chronic dissection, persistent false lumen perfusion, and adequacy of landing zone. Enthusiasm for improving the technique of open aortic repair and perioperative management is fading. In this study, we would like to demonstrate how we improve our surgical outcomes by establishing a dedicated aortic multidisciplinary team at the Kawasaki Aortic Center...
September 29, 2018: Journal of Thoracic and Cardiovascular Surgery
Chikara Ueki, Hiroshi Tsuneyoshi
No abstract text is available yet for this article.
October 14, 2018: Journal of Thoracic and Cardiovascular Surgery
Hongwei Zhang, Bangsheng Jia, Ling Zeng, Zhenghua Xiao, Jiayu Shen, Hong Qian, Eryong Zhang, Jia Hu
BACKGROUND: Thoracic endovascular aortic repair (TEVAR) is the therapeutic choice for type B aortic dissection. One of the most unfavored complications of this procedure is hemorrhage, which has a low incidence but high mortality. Renal hemorrhage (RH) after endovascular aortic repair has been rarely reported. We presented two cases of unexpected RH after TEVAR for complicated type B aortic dissection, and the potential causes, diagnosis and therapeutic management were discussed. CASE PRESENTATION: A 67-year-old female developed hypotension and progressively decrease of hemoglobin within 5 h after TEVAR for acute complicated type B dissection...
November 16, 2018: BMC Surgery
Mario D'Oria, Stefano Chiarandini, Marco Pipitone, Cristiano Calvagna, Barbara Ziani
OBJECTIVES: Our goal was to identify anatomical and physiological factors that could predict the amount of cerebrospinal fluid (CSF) drainage in patients undergoing elective endovascular repair of descending thoracic and thoracoabdominal aortic disease. METHODS: All consecutive elective endovascular procedures performed for descending thoracic or thoracoabdominal aortic disease between January 2015 and December 2017 were included in the study. Routine use of CSF drainage was established in all patients...
November 13, 2018: European Journal of Cardio-thoracic Surgery
Yong-Liang Zhong, Rui-Dong Qi, Wei-Guo Ma, Yi-Peng Ge, Zhi-Yu Qiao, Cheng-Nan Li, Jun-Ming Zhu, Li-Zhong Sun
Background: Several methods of arch vessel reconstruction, such as en bloc (island) and branched graft techniques, have been proposed to treat aortic arch pathologies during total arch replacement (TAR). We seek to review our experience with modified en bloc technique and left subclavian (LSCA)-left carotid artery (LCCA) transposition in TAR and frozen elephant trunk (FET) procedure for chronic type A aortic dissection (CTAAD). Methods: From September 2010 to September 2016, 35 consecutive patients with CTAAD underwent modified en bloc arch reconstruction with LSCA-LCCA transposition during TAR and FET procedure...
September 2018: Journal of Thoracic Disease
Satoru Takahashi, Sei Komatsu, Tomoki Ohara, Mitsuhiko Takewa, Yasuyuki Toyama, Chikao Yutani, Kazuhisa Kodama
A 73-year-old man reporting severe chest and back pain for 20 min was admitted to our hospital. The pain occurred 3 days before admission. Computed tomography angiography showed a hazy-surfaced low-density area in the aortic arch with aneurysmal formation of unknown etiology. It was inconclusive whether the aortic change was acute or chronic because no previous information was available. To investigate the etiology, non-obstructive angioscopy (NOA) was performed. A fissure with blood flow was detected at the surface of the low-density area and active subintimal blood flow was demonstrated on NOA...
November 2018: Journal of Cardiology Cases
Qing Li, Wei-Guo Ma, Jun Zheng, Yu Chen, Shang-Dong Xu, Yong-Min Liu, Jun-Ming Zhu, Lian-Jun Huang, Li-Zhong Sun
BACKGROUND: Experience is limited with distal stent graft-induced new entry (SINE) after endovascular thoracic aortic repair (TEVAR) of type B dissection (TBAD). We report the management strategy and outcomes in such patients. METHODS: Clinical data were analyzed for 95 patients (age 53.2±10.9 years; 82 males) developing distal SINE after TEVAR for TBAD. RESULTS: Follow-up was 100% (95/95) for 7.2±3 years after primary TEVAR. Distal SINE occurred at mean 2...
November 4, 2018: Annals of Thoracic Surgery
Eetu Niinimäk, Ville Pynnönen, Ivana Kholova, Timo Paavonen, Ari Mennander
OBJECTIVE: Neovascularization of the aortic wall may be associated with aortic dissection (AD). Aortic wall endothelial CD31 deposition together with chronic inflammation indicates angiogenesis that may lead to tissue disruption. We studied the presence of neovascularization of the ascending aortic wall by characterizing CD31 positive endothelial cells. METHODS: Aortic wall routine histology and immunohistochemistry for CD31, T- and B-lymphocytes, plasma cells, macrophages, endothelial cells, smooth muscle cells, and cell proliferation were performed on 35 selected patients who underwent surgery for the ascending aorta, and the samples were grouped according to the presence of AD...
November 2018: Anatolian Journal of Cardiology
Can Gollmann-Tepeköylü, Daniela Lobenwein, Markus Theurl, Uwe Primessnig, Daniela Lener, Elke Kirchmair, Wolfgang Mathes, Michael Graber, Leo Pölzl, Angela An, Katarzyna Koziel, Elisabeth Pechriggl, Jakob Voelkl, Patrick Paulus, Wolfgang Schaden, Michael Grimm, Rudolf Kirchmair, Johannes Holfeld
Background Mechanical stimulation of acute ischemic myocardium by shock wave therapy ( SWT ) is known to improve cardiac function by induction of angiogenesis. However, SWT in chronic heart failure is poorly understood. We aimed to study whether mechanical stimulation upon SWT improves heart function in chronic ischemic heart failure by induction of angiogenesis and postnatal vasculogenesis and to dissect underlying mechanisms. Methods and Results SWT was applied in a mouse model of chronic myocardial ischemia...
October 16, 2018: Journal of the American Heart Association
Binshan Zha, Geliang Xu, Huagang Zhu, Wentao Xie, Zhigong Zhang, Yongsheng Li, Peng Qiu
Purpose: The aim of this study was to present our experience and assess the morphologic changes of the descending aorta after the restrictive bare stent (RBS) technique in the treatment of type B aortic dissection (TBAD). Patients and methods: A retrospective study was conducted of 22 consecutive patients with TBAD who underwent RBS treatment between February 2012 and June 2016. Indications for the RBS procedure included radiological evidence of true lumen (TL) compression or collapse and/or tortuosity index (TI) of the descending aorta >1...
2018: Therapeutics and Clinical Risk Management
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