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Aortic arch dissection

Leili Pourafkari, Samad Ghaffari, Mojan Ahmadi, Rezvaniye Salehi, Sarvin Mazani, Raziyeh Parizad, Nader D Nader
OBJECTIVE: Aortic dissection is an uncommon and potentially fatal complication of pregnancy; however, the association of the number of pregnancies with the indexed and absolute size of ascending aorta in patients without aortic aneurysm or connective tissue disorders is not well elucidated. RESEARCH DESIGN AND METHODS: In this prospective observational study, women aged 18-80 years old undergoing transesophageal echocardiography in a university-affiliated echocardiography laboratory between January 1st 2015 and September 1st 2015 were enrolled...
March 16, 2018: Current Medical Research and Opinion
Mohamed A Mohamed, Kewan A Hamid
Acute aortic dissection (AAD) classically manifests with sudden, severe chest pain radiating to the back or abdomen, often described as ripping or tearing sensation. Considering its abrupt onset, the diagnosis requires a high index of suspicion prompting immediate imaging using computed tomography (CT) with contrast. However, the use of contrast is a relative contraindication in the patients with renal compromise and acute care physicians are often deterred from contrast use in these patients. Herein, we present an unusual case of hematuria as the presenting symptom of a developing the Stanford type-A AAD...
January 12, 2018: Curēus
Kyokun Uehara, Hitoshi Matsuda, Jiro Matsuo, Yosuke Inoue, Atsushi Omura, Yoshimasa Seike, Hiroaki Sasaki, Junjiro Kobayashi
AIM: To evaluate the surgical outcomes and midterm results of patients under 50 years old with acute type A aortic dissection (AAAD). METHODS: The study population included 51 patients who underwent AAAD repair between 2003 and 2016. Of these 51 patients, 46 (90.1%) were males and 14 (27.5%) had connective tissue disorders. Twenty-five patients (49.0%) had a body mass index >25.0 kg/m2 and two patients were pregnant. Total arch replacement was performed in 39 patients (76...
March 13, 2018: Journal of Cardiac Surgery
Yuwen Shen, Chuanzhen Liu, Changcun Fang, Jie Xi, Shuming Wu, Xinyan Pang, Guangmin Song
OBJECTIVE: To study the risk factors of oxygenation impairment in patients with type-A acute aortic dissection who underwent total arch replacement with a stented elephant trunk. METHODS: In this study, 169 consecutive patients were enrolled who were diagnosed with type-A acute aortic dissection and underwent a total arch replacement procedure at the Qilu Hospital of Shandong University between January 2015 and February 2017. Postoperative oxygenation impairment was defined as arterial oxygen partial pressure/inspired oxygen fraction ≤ 200 with positive end expiratory pressure ≥ 5 cm H2 O that occurred within 72 hours of surgery...
February 14, 2018: Journal of Thoracic and Cardiovascular Surgery
Kangjun Shen, Xinmin Zhou, Ling Tan, Feng Li, Jun Xiao, Hao Tang
BACKGROUND: We hypothesized that the arch-first procedure without extra devices under moderate-to-mild systemic hypothermia during acute type A aortic dissection is safe and efficient and will improve patient outcome compared with the standard total arch replacement technique. METHODS: From December 2014 to February 2017, 89 patients were enrolled in this study, 52 of whom underwent conventional deep hypothermic circulatory arrest (DHCA, 24.2 ± 0.71°C) using the antegrade cerebral perfusion surgical procedure (Group A) and 37 of whom underwent the "arch-first" technique with moderate (27...
March 12, 2018: Journal of Cardiovascular Surgery
Ingmar L Defize, Bernadette Schurink, Teus J Weijs, Tom A P Roeling, Jelle P Ruurda, Richard van Hillegersberg, Ronald L A W Bleys
BACKGROUND: Injury and subsequent leakage of unrecognized thoracic duct tributaries during transthoracic esophagectomy may lead to chylothorax. Therefore, we hypothesized that thoracic duct anatomy at the diaphragm is more complex than currently recognized and aimed to provide a detailed description of the anatomy of the thoracic duct at the diaphragm. BASIC PROCEDURES: The thoracic duct and its tributaries were dissected in 7 (2 male and 5 female) embalmed human cadavers...
March 3, 2018: Annals of Anatomy, Anatomischer Anzeiger: Official Organ of the Anatomische Gesellschaft
Nilukshana Yogendranathan, H M M T B Herath, W D Jayamali, Anne Thushara Matthias, Aruna Pallewatte, Aruna Kulatunga
BACKGROUND: Spinal cord infarction is an uncommon condition. Anterior cord syndrome present with paraparesis or quadriparesis with sparing of vibration and proprioceptive senses. The common causes of anterior cord syndrome are aortic dissection and aortic surgical interventions. Spontaneous unruptured nondissected aortic aneurysms with intramural thrombus can rarely cause anterior cord infarctions. CASE PRESENTATION: We report a case of anterior spinal cord syndrome due to aneurysm of the thoracic aorta with a mural thrombus...
March 5, 2018: BMC Cardiovascular Disorders
Keisuke Miyake, Toshihiro Funatsu, Haruhiko Kondoh, Kazuhiro Taniguchi
INTRODUCTION: Despite the technical improvements, redo surgery on the aortic root and arch is still associated with high morbidity and mortality due to the trauma of repeat open-heart surgery and technical complexity. We present the case of extended chronic type A dissecting aneurysm that developed after a Bentall operation, which was successfully treated by applying a modified long elephant trunk technique and surgical aortic fenestration. CASE PRESENTATION: A 77-year-old man, who had previously undergone a Bentall procedure and an abdominal surgery, developed a type A aortic dissection...
December 12, 2017: International Journal of Surgery Case Reports
N Rudarakanchana, M P Jenkins
BACKGROUND: Recent advances in endovascular technology have enabled minimally invasive repair of the aortic arch, with specifically designed stent-grafts. This article reviews hybrid and total endovascular repair in the management of aortic arch pathology. METHODS: Studies relating to aortic arch management were identified using MEDLINE and Embase, focusing on endovascular repair. RESULTS: Hybrid arch repair is associated with an early mortality rate of some 12 per cent, and carries significant risk of stroke (up to 15 per cent), paraplegia (up to 6 per cent), retrograde dissection (up to 6·5 per cent) and proximal endoleak (6 per cent)...
March 2018: British Journal of Surgery
R E Clough, R Spear, K Van Calster, A Hertault, R Azzaoui, J Sobocinski, D Fabre, S Haulon
BACKGROUND: Surgical repair of aortic arch pathology is complex and associated with significant morbidity and mortality. Alternative approaches have been developed to reduce these risks, including the use of thoracic stent-grafts with fenestrations or in combination with bypass procedures to maintain supra-aortic trunk blood flow. Branched stent-grafts are a novel approach to treat aortic arch pathology. METHODS: Consecutive patients with aortic arch disease presenting to a single university hospital vascular centre were considered for branched stent-graft repair (October 2010 to January 2017)...
March 2018: British Journal of Surgery
Ludovic Canaud, Pierre Alric
Degenerative aneurysms of the thoracic aorta are increasing in prevalence. The recognition of the decreased morbidity of this approach compared with open repair was readily apparent, as it avoided left thoracotomy, aortic cross-clamping, and left heart bypass. Repair of isolated descending thoracic aortic aneurysms using stent grafts was introduced in 1995, and in an anatomically suitable subgroup of patients with thoracic aortic aneurysm, repair with endovascular stent graft provides favorable outcomes, with decreased perioperative morbidity and mortality relative to open repair...
February 23, 2018: La Presse Médicale
Raphael Soler, Aurelien Vallee, Dominique Fabre, Stéphan Haulon
Endovascular treatment of thoracoabdominal aneurysms: what's new? Thoracoabdominal aneurysms (T-AAA) are aortic aneurysms that involve both the thoracic and abdominal segments of the aorta and its associated visceral branches. Although the first successful open repair was reported over 50 years ago, the risks of treatment remain considerable. As the first generations of devices available for endovascular aneurysm repair (EVAR) were relatively simple tubes or bifurcated grafts, initial attempts to extend the benefits of EVAR to patients with T-AAA lead to "hybrid solution"...
February 22, 2018: La Presse Médicale
Nicholas T Kouchoukos, Alexander Kulik, Catherine F Castner
OBJECTIVE: The study objective was to analyze clinical outcomes, distal segmental aortic growth, and aortic reoperation rates after 1-stage open repair of extensive chronic thoracic aortic dissection via bilateral anterior thoracotomy. METHODS: Eighty patients underwent extensive 1-stage repair of chronic aortic dissection that included the ascending aorta, the entire aortic arch, and the varying lengths of the descending thoracic aorta. One half or more of the descending thoracic aorta was replaced in 62 (78%) of the 80 patients...
January 31, 2018: Journal of Thoracic and Cardiovascular Surgery
Tim Berger, Maximilian Kreibich, Julia Morlock, Stoyan Kondov, Johannes Scheumann, Fabian A Kari, Bartosz Rylski, Matthias Siepe, Friedhelm Beyersdorf, Martin Czerny
OBJECTIVES: To evaluate early and mid-term clinical outcomes and to assess the potential of the frozen elephant trunk technique to induce remodelling of downstream aortic segments in acute and chronic thoracic aortic dissections. METHODS: Over a 4-year period, 65 patients (48 men, aged 61 ± 12 years) underwent total aortic arch replacement using the frozen elephant trunk technique for acute (n = 31) and chronic (n = 34) thoracic aortic dissections at our institution...
February 19, 2018: European Journal of Cardio-thoracic Surgery
Hiroshi Furukawa, Takeshi Honda, Takahiko Yamasawa, Hisao Masaki, Kazuo Tanemoto
BACKGROUND: We retrospectively evaluated the initial clinical experience of the surgical management of extensive dissecting thoracic aortic aneurysm (TAA) via the semi-clamshell approach. METHODS: Thirteen patients (3 women and 10 men, mean age 67 ± 15 years) who underwent elective surgical intervention for extensive dissecting TAA via semi-clamshell approach in our institute between May 2007 and April 2017 participated in this study. Regarding surgical techniques, left thoracotomy with transverse sternotomy was initially performed via the third or fourth intercostal space following an incision from the right sternal borderline to the anterior axillary line on the left sternal borderline...
February 22, 2018: General Thoracic and Cardiovascular Surgery
Marina Dias-Neto, José F Ramos, José F Teixeira
Injuries of the supra-aortic trunk after blunt chest trauma are rare. This is a case report of a blunt traumatic lesion of the innominate artery (IA) origin that exhibited aortic arch involvement with a focus on imaging and treatment. A 41-year-old fisherman presented an IA injury secondary to a high-impact blunt chest trauma. Upon physical examination, vital signs were stable and upper extremity pulses were present. In addition to several bone fractures (costal ribs, clavicle, scapula, temporal, maxillary, and sphenoid), computed tomography angiography revealed dissection/pseudoaneurysm of the IA sparing the bifurcation...
January 1, 2018: Vascular and Endovascular Surgery
Jonathan M Hemli, Bo Gu, S Jacob Scheinerman, Derek R Brinster
Total aortic arch replacement remains a technically formidable procedure, particularly in patients with previous proximal aortic dissection repair. Our case discussion highlights a useful strategy for extracorporeal support and circulation management to facilitate total arch reconstruction in the reoperative setting, based on cannulation of the left axillary artery. Our preference is to use a left axillary artery approach to initiate cardiopulmonary bypass and to ultimately revascularize the left arm via an extra-anatomic graft...
February 9, 2018: Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery
Joshua M Lader, Deane E Smith, Cezar Staniloae, Arzhang Fallahi, Sohah N Iqbal, Aubrey C Galloway, Mathew R Williams
A 78 year-old man with remote type-A dissection presented with acute-onset dyspnea. Twenty-two years prior, treatment for his aortic disease required replacement of ascending and arch aneurysms with a Dacron graft using graft inclusion technique. He presented currently in cardiogenic shock. Echocardiography demonstrated new severe hypokinesis of all apical segments. Left-heart catheterization revealed a 120mmHg intra-graft gradient. CT arteriography was unrevealing, but intra-aortic ultrasound demonstrated critical intra-graft stenosis...
February 8, 2018: Annals of Thoracic Surgery
G Tinelli, F Minelli, F De Nigris, C Vincenzoni, M Filipponi, P Bruno, M Massetti, A Flex, R Iezzi
OBJECTIVE: To evaluate the role of quantitative digital subtraction angiography (Q-DSA) with parametric color coding (PCC) in assessing patients with type B chronic thoracic aortic dissection (TBCAD) during thoracic endovascular aortic repair (TEVAR) procedures. PATIENTS AND METHODS: A total of 11 patients electively treated in our Department for a TBCAD were retrospectively enrolled. All cases were treated with TEVAR for false lumen aneurysm of the thoracic descending aorta...
January 2018: European Review for Medical and Pharmacological Sciences
Junichi Shimamura, Shin Yamamoto, Susumu Oshima, Kensuke Ozaki, Takuya Fujikawa, Shigeru Sakurai, Yuki Hirai, Tomohiro Hirokami, Nobukazu Moriya, Soichiro Hase, Tassei Nakagawa, Motoshige Yamasaki, Wataru Takayama, Shiro Sasaguri
OBJECTIVES: To evaluate the surgical outcomes of aortic repair via transapical cannulation and the adventitial inversion technique for acute Type A aortic dissection. METHODS: Between 2008 and 2015, a total of 300 patients with acute Type A aortic dissection underwent emergency surgery, consisting of 271 hemiarch repairs and 29 total aortic arch replacements, using transapical cannulation and the adventitial inversion technique at a distal anastomosis. The mean follow-up periods were 31...
February 6, 2018: European Journal of Cardio-thoracic Surgery
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