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Aortic arch dissection

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https://www.readbyqxmd.com/read/29136132/aortic-events-and-reoperations-after-elective-arch-surgery-incidence-surgical-strategies-and-outcomes
#1
Maximilian Luehr, Sven Peterss, Andreas Zierer, Davide Pacini, Christian D Etz, Malakh Lal Shrestha, Konstantinos Tsagakis, Bartosz Rylski, Giampiero Esposito, Klaus Kallenbach, Ruggero De Paulis, Paul P Urbanski
OBJECTIVES: The true incidence of aortic events (AEs) and reoperations (REDO) following elective total aortic arch replacement remains unknown. The aim of this study was to review the incidence of AEs and surgical REDO, and its respective outcomes after 1232 elective arch repairs at 11 European aortic centres. METHODS: Retrospective chart review (in the absence of prospective data collection) was performed for statistical analysis. Follow-up was conducted during routine clinical examination or in a telephone interview with patients and/or their respective physicians...
November 9, 2017: European Journal of Cardio-thoracic Surgery
https://www.readbyqxmd.com/read/29129420/surgical-strategy-for-the-treatment-of-aortoesophageal-fistula
#2
Takahiro Yamazato, Tetsu Nakamura, Noriyuki Abe, Koki Yokawa, Yuki Ikeno, Yojiro Koda, Soichiro Henmi, Hidekazu Nakai, Yasuko Gotake, Takashi Matsueda, Takeshi Inoue, Hiroshi Tanaka, Yoshihiro Kakeji, Yutaka Okita
OBJECTIVE: To present a surgical strategy for aortoesophageal fistula (AEF). METHODS: From October 1999 to May 2017, 27 patients with AEF were treated at Kobe University Hospital. After 9 patients with malignancies or fish bone penetration were excluded, 18 patients who had AEF secondary to aortic lesions were investigated. The mean age was 67.2 ± 10.4 years, and the male/female ratio was 16:2. Twelve patients had a nondissection thoracic aneurysm, and 6 patients had a chronic aortic dissection...
September 20, 2017: Journal of Thoracic and Cardiovascular Surgery
https://www.readbyqxmd.com/read/29123882/a-case-of-circumferential-type-a-aortic-dissection-with-intimal-intussusception-diagnosed-using-repeat-transthoracic-echocardiography-examination
#3
Toshinobu Yamagishi, Masahiro Kashiura, Kazuya Nakata, Kazuki Miyazaki, Takahiro Yukawa, Takahiro Tanabe, Kazuhiro Sugiyama, Akiko Akashi, Yuichi Hamabe
Case: Sometimes it is difficult to diagnose circumferential aortic dissection with enhanced computed tomography alone. A 58-year-old woman presented with sudden-onset chest discomfort and loss of consciousness. Transthoracic echocardiogram showed mild aortic regurgitation. Enhanced computed tomography scans showed no obvious intimal tear or flap at the proximal ascending aorta, but an intimal flap was observed from the aortic arch to both common iliac arteries. Stanford type B dissection was tentatively diagnosed...
July 2017: Acute Medicine & Surgery
https://www.readbyqxmd.com/read/29121846/retrograde-ascending-dissection-after-thoracic-endovascular-aortic-repair-combined-with-the-chimney-technique-and-successful-open-repair-using-the-frozen-elephant-trunk-technique
#4
Koji Hirano, Toshiya Tokui, Bun Nakamura, Ryosai Inoue, Masahiro Inagaki, Yasumi Maze, Noriyuki Kato
The chimney technique can be combined with thoracic endovascular aortic repair (TEVAR) to both obtain an appropriate landing zone and maintain blood flow of the arch vessels. However, surgical repair becomes more complicated if retrograde type A aortic dissection occurs after TEVAR with the chimney technique. We herein report a case involving a 73-year-old woman who developed a retrograde ascending dissection 3 months after TEVAR for acute type B aortic dissection. To ensure an adequate proximal sealing distance, the proximal edge of the stent graft was located at the zone 2 level and an additional bare stent was placed at the left subclavian artery (the chimney technique) at the time of TEVAR...
January 1, 2017: Vascular and Endovascular Surgery
https://www.readbyqxmd.com/read/29103584/selective-aortic-arch-and-root-replacement-in-repair-of-acute-type-a-aortic-dissection
#5
Fernando Fleischman, Ramsey S Elsayed, Robbin G Cohen, James M Tatum, S Ram Kumar, Kayvan Kazerouni, Wendy J Mack, Mark L Barr, Mark J Cunningham, Amy E Hackmann, Craig J Baker, Vaughn A Starnes, Michael E Bowdish
BACKGROUND: Controversy exists regarding the optimal extent of repair for type A aortic dissection. Our approach is to replace the ascending aorta, and only replace the aortic root or arch when intimal tears are present in those areas. We examined intermediate outcomes with this approach to acute type A aortic dissection repair. METHODS: Between March 2005 and October 2016, 195 patients underwent repair of acute type A aortic dissection. Repair was categorized by site of proximal and distal anastomosis and extent of repair...
November 3, 2017: Annals of Thoracic Surgery
https://www.readbyqxmd.com/read/29096576/endovascular-treatment-of-aortic-arch-lesions-using-scalloped-endografts
#6
Leopoldo Fernández-Alonso, Sebastián Fernández Alonso, Esther Martínez Aguilar, Estéfana Santamarta Fariña, Jordi Alegret Solé, Marina López San Martín, Margarita Atienza Pascual, Leopoldo Fernández-Domper, Roberto Centeno Vallepuga
OBJECTIVE: To present our early and midterm results using thoracic endovascular aortic repair (TEVAR) with a custom-made proximal scalloped stent graft to accommodate left common carotid artery (LCCA) and innominate artery (IA) in treating aortic lesions involving the arch. MATERIALS AND METHODS: Between February 2014 and April 2017, select patients presenting with aortic arch lesions and short proximal landing zone were treated by proximal scalloped Relay Plus stent grafts...
January 1, 2017: Vascular and Endovascular Surgery
https://www.readbyqxmd.com/read/29089284/morphology-and-outcomes-of-total-endovascular-treatment-of-type-b-aortic-dissection-with-aberrant-right-subclavian-artery
#7
Min Zhou, Xueqin Bai, Yong Ding, Yonggang Wang, Changpo Lin, Dong Yan, Zhenyu Shi, Weiguo Fu
OBJECTIVES: To characterize the morphology of type B aortic dissection with aberrant right subclavian artery (ARSA) and present early and midterm outcomes of total endovascular treatment for affected patients. METHODS: From January 2010 to December 2015, patients with ARSA and type B aortic dissection treated with total endovascular techniques were enrolled. The angle of the aortic arch was measured on pre-operative CTA. Sixty age and gender matched normal aortic arch patients with type B aortic dissection served as controls...
October 28, 2017: European Journal of Vascular and Endovascular Surgery
https://www.readbyqxmd.com/read/29075895/cerebral-ischaemia-following-anterior-upper-thoracic-spinal-surgery-utilizing-a-partial-manubrial-resection
#8
David Christopher Kieser, Derek Thomas Cawley, Takashi Fujishiro, Cecile Roscop, Louis Boissiere, Ibrahim Obeid, Olivier Gille, Jean-Marc Vital, Vincent Pointillart
PURPOSE: Firstly, to describe two cases of cerebral ischaemia complicating anterior upper thoracic spinal surgery and define the likely cause of this complication. Secondly, to describe preventative measures and the effect these have had in reducing this complication within our institution. METHODS: Firstly, a review of two cases of cerebral ischaemia complicating anterior upper thoracic spinal surgery utilizing a partial manubrial resection. Secondly, cadaveric dissections of the carotid arteries to determine the effect of neck positioning and aortic arch retraction during a simulated procedure...
October 26, 2017: European Spine Journal
https://www.readbyqxmd.com/read/29049833/intramurally-spreading-aortic-intimal-sarcoma-masquerading-as-ruptured-aortic-dissection
#9
Masaki Yamamoto, Makoto Hiroi, Tatsuya Noguchi, Kazumasa Orihashi
Preoperative diagnosis of aortic sarcomas is often difficult. Herein, we describe a case of a 68-year-old man who had an aortic intimal sarcoma with aortic wall hypertrophy that masqueraded as a thrombosed aortic dissection or mural thrombus on computed tomography. Because of the sudden appearance and rapid growth of the tumour surrounding the left subclavian artery with precordial pain and haemosputum, left subclavian arterial rupture caused by aortic dissection was suspected, requiring emergent total arch replacement...
September 1, 2017: Interactive Cardiovascular and Thoracic Surgery
https://www.readbyqxmd.com/read/29049830/acute-debakey-type-i-aortic-dissection-without-intimal-tear-in-the-arch-is-total-arch-replacement-the-right-choice
#10
Andrea Colli, Massimiliano Carrozzini, Annalisa Francescato, Marco Galuppo, Marina Comisso, Francesca Toto, Dario Gregori, Gino Gerosa
OBJECTIVES: Surgical management of acute DeBakey Type I aortic dissection without intimal tear in the aortic arch is controversial. This study compared short- and long-term outcomes of total arch replacement (TAR) versus limited ascending aorta/hemiarch replacement (no-TAR) in a consecutive series of patients. METHODS: Between January 1998 and December 2015, 220 consecutive patients were operated for DeBakey Type I acute aortic dissection; 135 cases did not exhibit an intimal entry tear in the aortic arch and were subsequently selected to comprise the primary study cohort...
July 31, 2017: Interactive Cardiovascular and Thoracic Surgery
https://www.readbyqxmd.com/read/29049816/triple-ultrasonography-for-iatrogenic-acute-aortic-dissection-caused-by-axillary-arterial-perfusion
#11
Masaki Yamamoto, Hideaki Nishimori, Miwa Tashiro, Kazumasa Orihashi
Iatrogenic aortic dissection caused by axillary arterial cannulation or perfusion becomes a fatal complication of cardiopulmonary bypass when surgeons do not recognize it in the surgical field of view immediately during surgery. Therefore, we routinely monitor the aorta using 'triple ultrasonography' during cardiovascular surgery. An 85-year-old woman underwent partial arch replacement for chronic type A aortic dissection. During cardiopulmonary bypass, acute aortic dissection was observed in the aortic arch from the right axillary artery on real-time transoesophageal echocardiography...
July 12, 2017: Interactive Cardiovascular and Thoracic Surgery
https://www.readbyqxmd.com/read/29049664/acute-type-i-aortic-dissection-a-propensity-matched-comparison-of-elephant-trunk-and-arch-debranching-repairs
#12
Mingjia Ma, Xin Feng, Jing Wang, Yiming Dong, Taiqiang Chen, Ligang Liu, Xiang Wei
OBJECTIVES: Our goal was to compare the performance of the frozen elephant trunk (FET) and the hybrid aortic arch debranching procedures for acute Type I aortic dissection. METHODS: From January 2013 to December 2015, 168 patients with Type I aortic disease underwent ascending aorta and total aortic arch replacement with FET implantation (the FET group, n  = 132) or arch debranching with 1-stage aortic arch exclusion using an endovascular stent in a retrograde manner (the debranching group, n  = 36)...
September 11, 2017: Interactive Cardiovascular and Thoracic Surgery
https://www.readbyqxmd.com/read/29038412/-effects-of-high-frequency-jet-ventilation-on-respiratory-failure-after-total-arch-replacement-due-to-acute-aortic-dissection-with-morbid-obesity-report-of-a-case
#13
Motoyuki Kumagai, Junichiro Nishizawa, Kazuhiro Takatoku, Takashi Ohba
A 55-year-old morbidly obese woman [body mass index (BMI) 51.2] developed acute type A aortic dissection, and she also presented with significant hypoxemia and hypercapnia. She underwent a successful emergency total arch replacement, but severe hypoxemia persisted and Pao2/Fio2 lowered to 71.9 mmHg. We therefore applied high frequency jet ventilation (HFJV), which soon improved the hypoxemia without hemodynamic compromise. HFJV was discontinued three days later, when her Pao2/Fio2 improved to 170.0 mmHg. Weaning from the respirator was initiated on postoperative day 13...
October 2017: Kyobu Geka. the Japanese Journal of Thoracic Surgery
https://www.readbyqxmd.com/read/29034028/endovascular-treatment-for-kommerell-s-diverticulum-with-a-right-sided-aortic-arch
#14
Masanori Hara, Takeshiro Fujii, Muneyasu Kawasaki, Tomoyuki Katayanagi, Shinnosuke Okuma, Noritsugu Shiono, Keiichi Tokuhiro, Yoshinori Watanabe
We report a rare case of type A dissection involving a right-sided aortic arch with an aberrant left subclavian artery originating from Kommerell's diverticulum in a 76-year-old woman. Endovascular treatment for Kommerell's diverticulum including intimal tear of the dissection was performed. At the 5-year follow-up, the patient was doing well, with no endoleak or dilatation of the Kommerell's diverticulum.
March 24, 2017: Annals of Vascular Diseases
https://www.readbyqxmd.com/read/29034023/retrograde-ascending-aortic-dissection-after-stent-grafting-for-stanford-type-b-aortic-dissection-with-severe-limb-ischemia
#15
Yoshiro Higuchi, Masato Tochii, Yoshiyuki Takami, Akihiro Kobayashi, Tsutomu Yanagisawa, Kentaro Amano, Yusuke Sakurai, Michiko Ishida, Hiroshi Ishikawa, Koji Hattori, Yasushi Takagi
We report a rare case of retrograde Stanford type A aortic dissection after endovascular repair for complicated Stanford type B aortic dissection. A 45-year-old man presented with a sudden onset of back pain and was transferred to our hospital. Computed tomography demonstrated acute Stanford type B aortic dissection with lower limb ischemia. Emergency endovascular surgery was planned for repair of the Stanford type B aortic dissection. The patient suddenly developed recurrent chest pain 10 days after the initial procedure...
March 24, 2017: Annals of Vascular Diseases
https://www.readbyqxmd.com/read/29022854/single-center-mid-term-experience-with-chimney-graft-technique-for-the-preservation-of-flow-to-the-supra-aortic-branches
#16
Robert Shahverdyan, Spyridon Mylonas, Michael Gawenda, Jan Brunkwall
Objectives To investigate the feasibility and the mid-term outcomes of the chimney-graft technique for the revascularization of supra-aortic branches in patients with thoracic aortic pathologies involving the aortic arch. Methods A retrospective analysis of a prospectively maintained database between January 2010 and July 2016 was performed. Primary endpoints were 30-day and overall mortality. Secondary endpoints were technical success, target vessel patency, stroke/transitory ischemic attack and type I/III endoleak rate...
January 1, 2017: Vascular
https://www.readbyqxmd.com/read/28993347/interrupted-aortic-arch-complicated-with-takotsubo-cardiomyopathy-mimicking-aortic-dissection
#17
Farhala Mari Baloch, Javed Majid Tai, Aamir Hameed Khan, Abdul Baqi
A 50-year-old man presented to the emergency department with interscapular pain, diaphoresis and restlessness. Initial examination raised the possibility of aortic dissection; however, the CT scan did not concur with the diagnosis. An ECG showed ST segment elevation in leads V1-V6 and echocardiography showed severe left ventricular systolic dysfunction. Coronary angiography through the right femoral artery was attempted but the diagnostic catheter could not be advanced to the ascending aorta. Radiocontrast injection showed complete obstruction of the descending aorta...
October 9, 2017: BMJ Case Reports
https://www.readbyqxmd.com/read/28977503/extended-versus-limited-arch-replacement-in-acute-type-a-aortic-dissection
#18
Magnus Larsen, Santi Trimarchi, Himanshu J Patel, Marco Di Eusanio, Kevin L Greason, Mark D Peterson, Rossella Fattori, Stuart Hutchison, Nimesh D Desai, Amit Korach, Daniel G Montgomery, Eric M Isselbacher, Christoph A Nienaber, Kim A Eagle, Kristian Bartnes, Truls Myrmel
OBJECTIVES: The recommended extent of surgical resection and reconstruction of the arch in acute DeBakey Type I aortic dissection is an ongoing controversy. However, several recent reports indicate a trend towards a more extensive arch operation in several institutions. We have analysed the recent data from the International Registry of Acute Aortic Dissection to assess the choice of procedure over time and to evaluate the surgical outcome in a 'real-world' database. Our aim was to compare short- and mid-term outcomes of limited repairs versus complete arch surgery...
July 12, 2017: European Journal of Cardio-thoracic Surgery
https://www.readbyqxmd.com/read/28977457/the-frozen-elephant-trunk-technique-for-the-treatment-of-acute-complicated-type-b-aortic-dissection
#19
Maximilian Kreibich, Tim Berger, Julia Morlock, Stoyan Kondov, Johannes Scheumann, Fabian A Kari, Bartosz Rylski, Matthias Siepe, Friedhelm Beyersdorf, Martin Czerny
OBJECTIVES: Our goal was to report our preliminary results in patients with acute complicated Type B aortic dissection without a suitable landing zone for primary thoracic endovascular aortic repair who were treated with the frozen elephant trunk (FET) technique. METHODS: Within a 25-month period, 14 patients with acute complicated Type B aortic dissection underwent surgical repair using the FET technique. The reasons to perform the FET procedure were an ectatic ascending aorta/arch in 6 patients and the lack of an adequate landing zone in 8 patients...
August 2, 2017: European Journal of Cardio-thoracic Surgery
https://www.readbyqxmd.com/read/28974497/outcomes-of-reoperation-after-acute-type-a-aortic-dissection-implications-for-index-repair-strategy
#20
Hanghang Wang, Matthew Wagner, Ehsan Benrashid, Jeffrey Keenan, Alice Wang, David Ranney, Babatunde Yerokun, Jeffrey G Gaca, Richard L McCann, G Chad Hughes
BACKGROUND: The optimal surgical approach for management of acute type A aortic dissection remains controversial. This study aimed to assess outcomes of reoperation after acute type A dissection repair to help guide decision making around index operative strategy. METHODS AND RESULTS: All aortic reoperations (n=129) at a single referral institution from August 2005 to April 2016 after prior acute type A dissection repair were reviewed. The primary outcome was 30-day or in-hospital mortality...
October 3, 2017: Journal of the American Heart Association
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