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Aortic arch dissection

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https://www.readbyqxmd.com/read/29349422/hybrid-management-of-a-ruptured-right-subclavian-artery-aneurysm-dissection
#1
David Drullinsky, Heather Gill, Jason P Bayne, Jean-Francois Morin, Daniel Obrand
Aberrant right subclavian artery is the most common congenital malformation of the aortic arch (0.4%-2.0%). Aneurysms of aberrant subclavian arteries are extremely rare. This results in little experience with their treatment. We describe a case of a patient who presented to the emergency department with a dissection of an aberrant right subclavian artery that later progressed to rupture. Besides hemodynamic instability, this caused an acute superior vena cava syndrome, making airway control difficult. In the operating room, we obtained proximal control through thoracic endovascular aortic repair; median sternotomy was performed for distal control and evacuation of massive hemomediastinum...
December 2017: Journal of Vascular Surgery Cases and Innovative Techniques
https://www.readbyqxmd.com/read/29340633/kinking-of-an-open-stent-graft-after-total-arch-replacement-with-the-frozen-elephant-technique-for-acute-type-a-aortic-dissection
#2
Akimasa Morisaki, Tadashi Isomura, Yasuhisa Fukada, Minoru Yoshida
Recently, in Japan, the J Graft Open Stent Graft (JOSG) was commercialized for surgical repair of an aortic aneurysm and aortic dissection and the frozen elephant trunk technique was applied. Kinking of the JOSG is a rare adverse event that requires additional intervention. We experienced 2 patients who developed kinking of a JOSG after translocated total arch replacement with the frozen elephant trunk technique for acute Type A aortic dissection. Both patients had intermittent claudication with a decreased ankle-brachial pressure index after the operation...
January 10, 2018: Interactive Cardiovascular and Thoracic Surgery
https://www.readbyqxmd.com/read/29338980/prevalence-of-bovine-aortic-arch-variant-in-patients-with-aortic-dissection-and-its-implications-in-the-outcome-of-patients-with-acute-type-b-aortic-dissection
#3
Spyridon N Mylonas, Arthurs Barkans, Marius Ante, Jens Wippermann, Dietmar Böckler, Jan Sigge Brunkwall
OBJECTIVE/BACKGROUND: To investigate the prevalence of bovine arch (BA) among patients with type A and B aortic dissection, and to provide insight into the implication of this variation on the outcome of patients with acute or subacute type B aortic dissection (a/sTBAD). METHODS: This retrospective cohort analysis includes patients with a/sTBAD admitted between January 2006 and December 2016. Computed tomographic angiograms (CTAs) of patients referred because of type A aortic dissection were also re-evaluated with regard to the presence of BA...
January 12, 2018: European Journal of Vascular and Endovascular Surgery
https://www.readbyqxmd.com/read/29336392/transesophageal-echocardiography-evaluation-of-the-aortic-arch-branches
#4
REVIEW
Thimmangouda A Patil, Santosh Kumar Ambli
Visualization of aortic arch branches by transesophageal echocardiography has been technically challenging. Visualizing these vessels helps in identifying the extent of dissection of the aorta, assessing the severity of carotid artery stenosis, presence of atheromatous plaques, patency of the left internal mammary artery graft, confirmation of subclavian artery cannulation, confirming holodiastolic flow reversal in the left subclavian artery by spectral Doppler imaging in case of severe aortic regurgitation, and confirming the optimal position of the intraaortic balloon perioperatively...
January 2018: Annals of Cardiac Anaesthesia
https://www.readbyqxmd.com/read/29334980/reoperation-for-a-giant-arch-anastomotic-pseudoaneurysm-eleven-years-after-total-arch-replacement-with-island-reconstruction
#5
Ryohei Matsuura, Yasushi Tsutsumi, Osamu Monta, Hisazumi Uenaka, Kenji Tanaka, Takaaki Samura, Hirokazu Ohashi
BACKGROUND: The long-term effects of some surgical treatment procedures of arch replacement for aortic dissection or aortic aneurysm are unknown. CASE PRESENTATION: The present study reports the case of a 68-year-old man admitted to our hospital for aortic arch anastomotic pseudoaneurysm with concomitant aortic root enlargement and coronary artery stenosis. Eleven years ago, at the age of 56 years, he underwent total arch replacement with island reconstruction for chronic aortic dissection...
January 15, 2018: Journal of Cardiothoracic Surgery
https://www.readbyqxmd.com/read/29290662/combined-thoracoscopic-and-endoscopic-surgery-for-a-large-esophageal-schwannoma
#6
Yu Onodera, Toru Nakano, Daisuke Takeyama, Shota Maruyama, Yusuke Taniyama, Tadashi Sakurai, Takahiro Heishi, Chiaki Sato, Takuro Kumagai, Takashi Kamei
A 47-year-old woman presented to our hospital with complaints of dysphagia. Esophagogastroduodenoscopy identified a submucosal tumor in the left wall of the esophagus that was diagnosed as a benign schwannoma on biopsy. Computed tomography revealed a tumor of length 60 mm in the thoracic esophagus, with its cranial edge at the level of the aortic arch. On endoscopy, a submucosal tunnel was created 40 mm proximal to the cranial edge of the tumor, and its oral end was dissected from the mucosal and muscular layers...
December 14, 2017: World Journal of Gastroenterology: WJG
https://www.readbyqxmd.com/read/29290421/patient-specific-three-dimensional-printing-for-kommerell-s-diverticulum
#7
Xiaoning Sun, Hongqiang Zhang, Kai Zhu, Chunsheng Wang
BACKGROUND: Kommerell's diverticulum is a complex congenital malformation of aorta. Three-dimensional (3D) printing is an innovative manufacturing process that allows computer-assisted conversion of 3D imaging data into physical "printouts." The aim of this study was to explore the feasibility and impact of using patient-specific 3D-printed cardiac prototypes derived from computed tomography data on surgical decision-making and preoperative planning for Kommerell's diverticulum. METHODS: From April to August 2017, five patients with Kommerell's diverticulum were diagnosed and chosen for study...
December 26, 2017: International Journal of Cardiology
https://www.readbyqxmd.com/read/29285704/direct-perfusion-of-the-carotid-artery-in-patients-with-brain-malperfusion-secondary-to-acute-aortic-dissection
#8
Yutaka Okita, Yuki Ikeno, Koki Yokawa, Yojiro Koda, Soichiro Henmi, Yasuko Gotake, Hidekazu Nakai, Takashi Matsueda, Takeshi Inoue, Hiroshi Tanaka
OBJECTIVE: Presenting our experience of direct perfusion of the carotid artery in patients with brain malperfusion secondary to acute aortic dissection. PATIENTS: Among 381 patients who underwent aortic repair for acute type A aortic dissection from October 1999 to August 2017, brain malperfusion was recognized in 50 patients. Nine patients had direct perfusion of the right carotid artery in patients with brain malperfusion secondary to acute aortic dissection. Age at surgery was 65...
December 28, 2017: General Thoracic and Cardiovascular Surgery
https://www.readbyqxmd.com/read/29279888/prevalence-of-systemic-atherosclerosis-burdens-and-overlapping-stroke-etiologies-and-their-associations-with-long-term-vascular-prognosis-in-stroke-with-intracranial-atherosclerotic-disease
#9
Takao Hoshino, Leila Sissani, Julien Labreuche, Gregory Ducrocq, Philippa C Lavallée, Elena Meseguer, Céline Guidoux, Lucie Cabrejo, Cristina Hobeanu, Fernando Gongora-Rivera, Pierre-Jean Touboul, Philippe Gabriel Steg, Pierre Amarenco
Importance: Patients who have experienced stroke with intracranial atherosclerotic disease (ICAD) may also have concomitant atherosclerosis in different arterial beds and other possible causes for ischemic stroke. However, little is known about the frequency and prognostic effect of such overlapping diseases. Objectives: To describe the prevalence of systemic atherosclerotic burdens and overlapping stroke etiologies and their contributions to long-term prognoses among patients who have experienced stroke with ICAD...
December 26, 2017: JAMA Neurology
https://www.readbyqxmd.com/read/29276439/endovascular-treatment-of-distal-aortic-arch-aneurysm-associated-with-coarctation-of-aorta-in-a-jehovah-s-witness
#10
Luigi Di Tommaso, Vito A Mannacio, Ettorino Di Tommaso, Giovanni B Pinna, Immacolata Fontana, Gabriele Iannelli
Late aneurysm formation in the proximal aorta or distal aortic arch is a recognized sequela of untreated stenosis of the aortic isthmus and is associated with substantial risk of aortic rupture. We describe the case of a 44-year-old man with untreated coarctation of the aorta who presented with a prestenotic dissecting thoracic aortic aneurysm. He declined surgery because he was a Jehovah's Witness. Instead, we performed emergency endovascular aortic repair in which 2 stent-grafts were placed in the descending aorta...
December 2017: Texas Heart Institute Journal
https://www.readbyqxmd.com/read/29276106/natural-history-of-the-proximal-aorta-in-patients-with-descending-thoracic-aortic-disease
#11
Paul C Tang, Paul D DiMusto, Nilto C De Oliveira, Brooks L Rademacher, Jennifer L Philip, Shahab A Akhter, Charles W Acher
OBJECTIVE: This study investigated the growth and behavior of the ascending aorta in patients with descending thoracic aortic disease. METHODS: We examined 200 patients with descending thoracic aortic disease including acute type B dissection (n = 95), chronic type B dissection (n = 38), intramural hematoma (n = 23), and thoracoabdominal aortic aneurysms (n = 44). Images from computed tomography and magnetic resonance imaging were evaluated after three-dimensional reconstruction to examine the growth rate in those with >1 year of imaging follow-up (n = 108)...
December 21, 2017: Journal of Vascular Surgery
https://www.readbyqxmd.com/read/29274694/acute-type-a-aortic-dissection-causing-collapse-of-previous-stent-graft
#12
Ha-Eun Kim, Hyun-Chel Joo
A 69-year old man presented to the emergency department with back pain and paraplegia. Computed tomography showed acute type A aortic dissection with primary tear right below the origin of the left subclavian artery. He had undergone endovascular aneurysm repair (EVAR) 13 months earlier, and the previously inserted EVAR graft totally collapsed. Total arch replacement covering primary entry tear was performed. Femoral pulse was undetected prior to surgery, but was monitored post-surgically after cardiopulmonary bypass weaning...
December 21, 2017: Annals of Thoracic Surgery
https://www.readbyqxmd.com/read/29249769/open-conversion-for-type-a-ascending-aortic-dissection-after-thoracic-endovascular-aortic-repair-by-the-chimney-graft-technique
#13
Hirofumi Kasahara, Yoshito Inoue, Takashi Hachiya
An 83-year-old man with aortic arch aneurysm underwent zone 0 thoracic endovascular aortic repair (TEVAR) by the chimney graft technique with two supra-aortic arch debranching grafts and developed subacute type A ascending aortic dissection. We performed emergency open conversion with circulatory arrest under deep hypothermia. The tip of the chimney graft (around the sino-tubular junction in the ascending aorta) was stiff, making it difficult to inspect the lumen and perform anastomosis. Deep hypothermic circulatory arrest and cutting the endograft stents to mobilize the graft were necessary for secure anastomosis...
December 18, 2017: Annals of Thoracic and Cardiovascular Surgery
https://www.readbyqxmd.com/read/29242940/clinics-in-diagnostic-imaging-182-acute-descending-aortic-dissection-with-aortic-root-retrograde-extension
#14
John Nathan Gifford, Angeline Choo Choo Poh
A 77-year-old man presented with acute-onset severe chest pain radiating to the back and elevated blood pressure. Multiphasic computed tomography of the aorta revealed an intimal tear in the descending thoracic aorta which extended both retrograde to the aortic root and antegrade to the infra-renal abdominal aorta. The initial impression, that the images showed a Stanford type B aortic dissection, was because the portion of the false lumen that extended beyond the aortic arch remained unopacified even on delayed phases, making it challenging to assess the extent of the dissection flap...
December 2017: Singapore Medical Journal
https://www.readbyqxmd.com/read/29242743/open-repair-management-of-a-patient-with-aortic-arch-saccular-aneurysm-penetrating-atherosclerotic-ulcer-one-vessel-coronary-artery-disease-and-an-isolated-dissection-of-the-abdominal-aorta
#15
Harvey Romolo, Dicky A Wartono, Sugisman Suyuti, Bagus Herlambang, Michael Caesario, Ismoyo Sunu
Isolated saccular compared to fusiform aneurysm is considered to be a rare entity with challenges of its own. A 62-year-old female was diagnosed with a case of saccular aneurysm and penetrating atherosclerotic ulcer of the aortic arch. Additionally, she also had one vessel coronary artery disease and type B abdominal aortic dissection. She was then managed with open aortic arch repair and coronary artery bypass grafting. If required, elective endovascular repair will be done for the abdominal aorta on a later date...
2017: SAGE Open Medical Case Reports
https://www.readbyqxmd.com/read/29240061/-hybrid-treatment-of-patients-with-aneurysms-and-dissections-of-the-aortic-arch-and-descending-portion-of-the-thoracic-aorta
#16
V V Shlomin, M L Gordeev, D A Zverev, E A Shloĭdo, V E Uspenskiĭ, E D Zvereva, P B Bondarenko, P D Puzdriak
The authors share herein their experience with hybrid surgical treatment of 21 patients presenting with lesions of the aortic arch and descending thoracic aorta. Aortic pathology included dissection of the thoracoabdominal aorta (n=15), a sacciform aneurysm of the aortic arch (n=5), and a spindle-shaped aneurysm of the distal portions of the aortic arch (n=1). The first stage consisted of the following operations: transposition of the left subclavian artery into the left common carotid artery (n=9; 42.8%), partial debranching (n=11; 52...
2017: Angiologii︠a︡ i Sosudistai︠a︡ Khirurgii︠a︡, Angiology and Vascular Surgery
https://www.readbyqxmd.com/read/29237361/hybrid-endovascular-aortic-arch-reconstruction-for-acute-aortic-dissection-an-endovascular-bridge-technique-for-complex-anatomy
#17
Michael P Rogers, Sophie M Reskin, Adam Ubert, Matthew C Black, Kendra J Grubb
Acute type A aortic dissections starting at the arch pose a challenge for cardiac surgeons. Open surgical repair requires deep hypothermic circulatory arrest for arch reconstruction and is associated with significant morbidity and mortality. Hybrid aortic repair techniques, with open arch debranching and thoracic endovascular aortic repair, have been employed in high-risk cases and challenging aortic pathology. Herein, we present a case of a 33-year-old African American male with a history of open thoracoabdominal aortic reconstruction and femoral-femoral artery bypass for a type B dissection who subsequently presented with new-onset chest pain and was found to have a retrograde type A dissection of a bovine arch with multiple dissection flaps and possible contrast extravasation on chest computed tomography...
January 1, 2017: Vascular and Endovascular Surgery
https://www.readbyqxmd.com/read/29225128/aortic-anatomy-and-complications-of-the-proximal-sealing-zone-after-endovascular-treatment-of-the-thoracic-aorta
#18
Jérémie Peidro, Mourad Boufi, Anderson Loundou, Olivier Hartung, Bianca Dona, Florent Vernet, David Bensoussan, Yves Alimi
BACKGROUND: The technical and clinical success of the thoracic aortic endovascular procedures rests mainly on the choice of the proximal sealing zone (PSZ). The latter can be the affected by multiple complications, all of them having a potential gravity and a direct link with the quality of the PSZ. The objective of this study was to analyze the risk factors of the occurrence of complications of the PSZ. METHODS: Between 2007 and 2015, all the patients treated by a thoracic stentgraft in zones 2, 3, or 4 were retrospectively reviewed, with analysis of the pre- and postoperative angio-CT...
December 7, 2017: Annals of Vascular Surgery
https://www.readbyqxmd.com/read/29221269/cluster-analysis-of-acute-ascending-aortic-dissection-provides-novel-insight-into-mechanisms-of-distal-progression
#19
Jennifer L Philip, Nilto C De Oliveira, Shahab A Akhter, Brooks L Rademacher, Christopher B Goodavish, Paul D DiMusto, Paul C Tang
Background: Whether primary tear size impacts extent of type A dissection is unclear. Using statistical groupings based on dissection morphology, we examined its relationship to primary tear area. Methods: We retrospectively reviewed 108 patients who underwent acute ascending dissection repair from 2000-2016. Dissection morphology was characterized using 3-dimensional (3D) reconstructions of computed tomography (CT) scan images. Two-step cluster analysis was performed to group the dissections by examining the true lumen area as a fraction of the total aortic area at various levels...
September 2017: Journal of Thoracic Disease
https://www.readbyqxmd.com/read/29211214/hybrid-approach-of-aortic-diseases-zone-1-delivery-and-volumetric-analysis-on-the-descending-aorta
#20
José Augusto Duncan, Ricardo Ribeiro Dias, Fabrício José Dinato, Fábio Fernandes, Félix José Álvares Ramirez, Charles Mady, Fabio Biscegli Jatene
INTRODUCTION: Conventional techniques of surgical correction of arch and descending aortic diseases remains as high-risk procedures. Endovascular treatments of abdominal and descending thoracic aorta have lower surgical risk. Evolution of both techniques - open debranching of the arch and endovascular approach of the descending aorta - may extend a less invasive endovascular treatment for a more extensive disease with necessity of proximal landing zone in the arch. OBJECTIVE: To evaluate descending thoracic aortic remodeling by means of volumetric analysis after hybrid approach of aortic arch debranching and stenting the descending aorta...
September 2017: Brazilian Journal of Cardiovascular Surgery
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