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https://www.readbyqxmd.com/read/27921203/treatment-of-uncomplicated-type-b-aortic-dissection
#1
REVIEW
Hitoshi Matsuda
Hospital mortality after the replacement of chronic type B aortic dissection is around 8-10% and adverse outcomes include paraplegia and stroke. However, the level of evidence for indication of thoracic endovascular aortic repair (TEVAR) for type B chronic aortic dissection is Class IIa. Results of the INSTEAD-XL trial have verified that preemptive TEVAR for uncomplicated type B aortic dissection improves prognosis. The indication for this procedure is reportedly a maximum aortic diameter >40 mm during the acute phase and a patent primary entry site in the thoracic aorta, while the optimal timing for TEVAR would be the subacute phase, from 2 weeks to 3-6 months after onset...
December 5, 2016: General Thoracic and Cardiovascular Surgery
https://www.readbyqxmd.com/read/27909279/-stanford-type-a-aortic-dissection-after-off-pump-coronary-artery-bypass-grafting-using-automated-proximal-anastomotic-device-report-of-a-case
#2
Toshiyuki Maeda, Taku Sakurada, Satoshi Muraki, Shinji Nakashima, Jun Sasaki, Eiji Araki
Operative mortality of Stanford type A aortic dissection( AAD) repair with previous cardiac surgery is high, especially with previous coronary artery bypass grafting. We report an extremely rare case of AAD related to the PAS-Port system. A 68-year-old male patient on dialysis was admitted to our hospital with a diagnosis of AAD. Half a year before he had undergone off-pump coronary artery bypass grafting using PAS-Port system for a proximal anastomosis of a vein graft. Urgent graft replacement of the ascending aorta was performed, and the proximal anastomotic site of the vein graft was attached to the prosthetic graft...
December 2016: Kyobu Geka. the Japanese Journal of Thoracic Surgery
https://www.readbyqxmd.com/read/27909276/-closure-of-ascending-aortic-entry-by-debranching-endovascular-management-in-an-elderly-patient-with-acute-stanford-type-a-dissection
#3
Munehiro Saiki, Keiji Yunoki, Naoya Sakoda, Shigeru Hattori, Gaku Uchino, Takuya Kawabata, Yasufumi Fujita, Kunikazu Hisamochi, Hideo Yoshida
An 85-year-old woman was hospitalized by emergency for an acute Stanford type A aortic dissection. Computed tomography showed a primary entry on the ascending aorta and pericardial effusion. Although her hemodynamics was unstable due to cardiac shock, her family wished no open surgery considering her age and frailty. A couple of days later, her condition became stabilized with antihypertensive therapy. Since the dissection was limited within the ascending aorta, closure of the entry with the stentgraft was considered appropriate and much less invasive as compared with an open surgery...
December 2016: Kyobu Geka. the Japanese Journal of Thoracic Surgery
https://www.readbyqxmd.com/read/27903487/disturbed-p53-mdm2-feedback-loop-contributes-to-thoracic-aortic-dissection-formation-and-may-be-a-result-of-trim-25-overexpression
#4
Bin Gong, Zhiwei Wang, Min Zhang, Zhipeng Hu, Zongli Ren, Zheng Tang, Wanli Jiang, Lianghao Cheng, Jun Huang, Wei Ren, Qingtao Wang
BACKGROUND: The development of thoracic aortic dissection (TAD) is attributed to a broad range of degenerative, genetic, structural, oxidative, apoptotic, and acquired disease states. In this study, we examined the role of the disturbed p53-MDM2 feed-back loop in the formation of TAD, and one of a potential feed-back loop regulator, TRIM-25. METHODS: Surgical specimens of the aorta from TAD patients (n=10) and controls (n=10) were tested for α-smooth muscle actin (α-SMA),p53,murine double minute2(MDM2) and tripartite motif protein-25(TRIM-25) by western blot, immunohistochemical staining and quantitative real-time reverse transcription polymerase chain reaction (qRT-PCR) , respectively...
November 26, 2016: Annals of Vascular Surgery
https://www.readbyqxmd.com/read/27903476/rapid-aneurysmal-sac-expansion-following-endovascular-repair-of-a-dissecting-thoracoabdominal-aneurysm
#5
Pau Bargay-Juan, Teresa Martin-Gonzalez, Rachel Clough, Rafaëlle Spear, Jonathan Sobocinski, Stephan Haulon
Endovascular repair of dissecting thoracoabdominal aneurysms (TAAA) is challenging and often requires multiple procedures. A 61-year-old man with a dissecting type-II TAAA treated first by placement of a thoracic endograft, and subsequently implantation of a fenestrated endograft. Six months postoperatively, a 10mm increase of the aorta was observed. A re-entry tear in left external iliac artery(EIA) was perfusing the false lumen in a retrograde fashion connecting with the endoleak caused by the inferior mesenteric artery and lumbar arteries...
November 26, 2016: Annals of Vascular Surgery
https://www.readbyqxmd.com/read/27893734/an-ipsc-derived-vascular-model-of-marfan-syndrome-identifies-key-mediators-of-smooth-muscle-cell-death
#6
Alessandra Granata, Felipe Serrano, William George Bernard, Madeline McNamara, Lucinda Low, Priya Sastry, Sanjay Sinha
Marfan syndrome (MFS) is a heritable connective tissue disorder caused by mutations in FBN1, which encodes the extracellular matrix protein fibrillin-1. To investigate the pathogenesis of aortic aneurysms in MFS, we generated a vascular model derived from human induced pluripotent stem cells (MFS-hiPSCs). Our MFS-hiPSC-derived smooth muscle cells (SMCs) recapitulated the pathology seen in Marfan aortas, including defects in fibrillin-1 accumulation, extracellular matrix degradation, transforming growth factor-β (TGF-β) signaling, contraction and apoptosis; abnormalities were corrected by CRISPR-based editing of the FBN1 mutation...
November 28, 2016: Nature Genetics
https://www.readbyqxmd.com/read/27893044/failure-of-the-porcine-ascending-aorta-multidirectional-experiments-and-a-unifying-microstructural-model
#7
Colleen M Witzenburg, Rohit Y Dhume, Sachin B Shah, Christopher E Korenczuk, Hallie P Wagner, Patrick W Alford, Victor H Barocas
The ascending thoracic aorta is poorly understood mechanically, especially its risk of dissection. To make better predictions of dissection risk, more information about the multi-dimensional failure behavior of the tissue is needed, and this information must be incorporated into an appropriate theoretical / computational model. Towards the creation of such a model, uniaxial, equibiaxial, peel, and shear lap tests were performed on healthy porcine ascending aorta samples. Uniaxial and equibiaxial tests showed anisotropy with greater stiffness and strength in the circumferential direction...
November 18, 2016: Journal of Biomechanical Engineering
https://www.readbyqxmd.com/read/27890847/fenestrated-and-branched-stent-grafting-in-complex-aneurysmatic-aortic-disease-a-single-center-early-experience
#8
Georgios D Vourliotakis, Vasileios D Tzilalis, Panagiotis G Theodoridis, Charalampos S Stoumpos, Dimitrios G Kamvysis, Giannis G Kantounakis
PURPOSE: To present our early experience and highlight the technical difficulties associated with the use of fenestrated and branched stent-grafts to treat patients with juxta-, para-renal abdominal aortic aneurysms (AAA) and thoracoabdominal aortic aneurysms (TAAA). METHODS: A prospectively held database maintained at our department, was queried for patients who have undergone branched and fenestrated stent-grafting for AAA or TAAA treatment. Indication for repair, co-morbidity precluding open repair, technical challenges associated with the repair, as well as operative mortality, morbidity and re-intervention rate were evaluated...
November 24, 2016: Annals of Vascular Surgery
https://www.readbyqxmd.com/read/27890843/total-endovascular-aortic-repair-in-a-patient-with-marfan-syndrome
#9
Mau Amako, Rafaëlle Spear, Rachel E Clough, Adrien Hertault, Richard Azzaoui, Teresa Martin Gonzalez, Jonathan Sobocinski, Stéphan Haulon
OBJECTIVE: To describe a total endovascular aortic repair with branched and fenestrated endografts in a young patient with Marfan syndrome and a chronic aortic dissection. Open surgery is the gold standard to treat aortic dissections in patients with aortic disease and Marfan syndrome. METHODS: In 2000, a 38-year-old man with Marfan syndrome underwent open ascending aorta repair for an acute type A aortic dissection. One year later, a redo sternotomy was performed for aortic valve replacement...
November 24, 2016: Annals of Vascular Surgery
https://www.readbyqxmd.com/read/27887856/preoperative-thoracic-false-lumen-branches-relate-to-aortic-remodeling-after-thoracic-endovascular-aortic-repair-for-debakey-iiib-aortic-dissection
#10
Yang Yang Ge, Wei Guo, Nick Cheshire, Xiao Ping Liu, Xin Jia, Jiang Xiong, Xiao Hui Ma, Hong Peng Zhang
OBJECTIVE: This study evaluated the association between thoracic false lumen branches (TFLBs; dissected thoracic branches fed by a false lumen) and distal thoracic aortic enlargement (DTAE) after thoracic endovascular aortic repair (TEVAR) for DeBakey IIIb aortic dissection. METHODS: We retrospectively analyzed the records of 67 patients with DeBakey IIIb dissection initially treated with TEVAR between January 2011 and December 2013. Preoperative and postoperative computed tomography angiography images were reviewed to evaluate the number of preoperative TFLBs and aortic diameter change after TEVAR...
November 22, 2016: Journal of Vascular Surgery
https://www.readbyqxmd.com/read/27883977/age-related-changes-of-thoracic-aorta-geometry-used-to-predict-the-risk-for-acute-type-b-dissection
#11
Damian Craiem, Salma El Batti, Mariano E Casciaro, Elie Mousseaux, Marie-Emmanuelle Sirieix, Alain Simon, Jean-Marc Alsac
AIMS: Risk models that use a single aortic diameter threshold have failed to successfully predict acute type B aortic dissection (TBAD). We sought to identify meaningful age-indexed anatomical variables to predict TBAD risk. METHODS AND RESULTS: A geometric deformable model, consisting of virtual elastic balloons that inflate inside a vessel lumen, was developed to quantify thoracic aorta geometry. In the presence of TBAD, true and total artery lumen morphology were assessed...
November 9, 2016: International Journal of Cardiology
https://www.readbyqxmd.com/read/27882488/quantification-of-motion-of-the-thoracic-aorta-after-ascending-aortic-repair-of-type-a-dissection
#12
Ga-Young Suh, Dominik Fleischmann, Ramin E Beygui, Christopher P Cheng
PURPOSE: To quantify cardiac and respiratory deformations of the thoracic aorta after ascending aortic graft repair. METHODS: Eight patients were scanned with cardiac-resolved computed tomography angiography during inspiratory/expiratory breath-holds. Aortic centerlines and lumen were extracted to compute the arclength, curvature, angulation, and cross-section shape. RESULTS: From systole to diastole, the angle of graft [Formula: see text] arch increased by 2...
November 23, 2016: International Journal of Computer Assisted Radiology and Surgery
https://www.readbyqxmd.com/read/27881689/acute-type-a-aortic-dissection-treated-using-a-tubular-stent-graft-in-the-ascending-aorta-and-a-multibranched-stent-graft-in-the-aortic-arch
#13
Tilo Kölbel, Christian Detter, Sebastian W Carpenter, Fiona Rohlffs, Yskert von Kodolitsch, Sabine Wipper, Herrmann Reichenspurner, E Sebastian Debus, Nikolaos Tsilimparis
PURPOSE: To describe the combined use of a tubular stent-graft for the ascending aorta and an inner-branched arch stent-graft for patients with acute type A aortic dissection. TECHNIQUE: The technique to deploy these modular, custom-made stent-grafts is demonstrated in 2 patients with acute DeBakey type I aortic dissections and significant comorbidities precluding open surgery. Both emergent procedures were made possible by the availability of suitable devices manufactured for elective repair in other patients...
November 23, 2016: Journal of Endovascular Therapy
https://www.readbyqxmd.com/read/27879966/andrological-complications-following-retroperitoneal-lymphnode-dissection-for-testicular-cancer-a-narrative-review
#14
Alessandro Crestani, Francesco Esperto, Marta Rossanese, Gianluca Giannarini, Nicola Nicolai, Vincenzo Ficarra
Retroperitoneal lymphnode dissection (RPLND) is a fundamental surgical step in the treatment of testicular cancer. Nowadays primary RPLND has partially lost its role in favour of active surveillance (for low risk stage I disease) and short cycle chemotherapy in non-seminomatous germ cell tumour (NSGCT). Conversely, postchemotherapy-RPLND (PC-RPLND) remains the standard treatment for residual masses after chemotherapy. In consideration of curability rate of testicular cancer and the life expectancy of testicular cancer survivors the identification and the prevention of andrological complications became fundamental...
November 23, 2016: Minerva Urologica e Nefrologica, the Italian Journal of Urology and Nephrology
https://www.readbyqxmd.com/read/27879251/altered-smooth-muscle-cell-force-generation-as-a-driver-of-thoracic-aortic-aneurysms-and-dissections
#15
REVIEW
Dianna M Milewicz, Kathleen M Trybus, Dongchuan Guo, H Lee Sweeney, Ellen Regalado, Kristine Kamm, James T Stull
The importance of maintaining contractile function in aortic smooth muscle cells (SMCs) is evident by the fact that heterozygous mutations in the major structural proteins or kinases controlling contraction lead to the formation of aneurysms of the ascending thoracic aorta that predispose to life-threatening aortic dissections. Force generation by SMC requires ATP-dependent cyclic interactions between filaments composed of SMC-specific isoforms of α-actin (encoded by ACTA2) and myosin heavy chain (MYH11). ACTA2 and MYH11 mutations shown to disrupt this cyclic interaction predispose to thoracic aortic disease...
November 22, 2016: Arteriosclerosis, Thrombosis, and Vascular Biology
https://www.readbyqxmd.com/read/27873227/the-relationship-between-aortic-root-size-and-hypertension-an-unsolved-conundrum
#16
Giuseppe Mulè, Emilio Nardi, Massimiliano Morreale, Antonella Castiglia, Giulio Geraci, Dario Altieri, Valentina Cacciatore, Margherita Schillaci, Francesco Vaccaro, Santina Cottone
Thoracic aortic aneurysms rupture and dissection are among the most devastating vascular diseases, being characterized by elevated mortality, despite improvements in diagnostic imaging and surgical techniques.An increased aortic root diameter (ARD) represents the main risk factor for thoracic aortic dissection and rupture and for aortic valve regurgitation.Even though arterial hypertension is commonly regarded as a predisposing condition for the development of thoracic aorta aneurysms, the role of blood pressure (BP) as determinant of aortic root enlargement is still controversial...
November 22, 2016: Advances in Experimental Medicine and Biology
https://www.readbyqxmd.com/read/27871094/biomechanical-responses-of-pmhs-subjected-to-abdominal-seatbelt-loading
#17
Rakshit Ramachandra, Yun-Seok Kang, John H Bolte, Alena Hagedorn, Rodney Herriott, Jason A Stammen, Kevin Moorhouse
Past studies have found that a pressure based injury risk function was the best predictor of liver injuries due to blunt impacts. In an effort to expand upon these findings, this study investigated the biomechanical responses of the abdomen of post mortem human surrogates (PMHS) to high-speed seatbelt loading and developed external response targets in conjunction with proposing an abdominal injury criterion. A total of seven unembalmed PMHS, with an average mass and stature of 71 kg and 174 cm respectively were subjected to belt loading using a seatbelt pull mechanism, with the PMHS seated upright in a freeback configuration...
November 2016: Stapp Car Crash Journal
https://www.readbyqxmd.com/read/27866548/-effect-of-heme-oxygenase-1-transduced-by-cell-penetrating-peptide-pep-1-on-renal-injury-in-rats-with-acute-paraquat-poisoning
#18
X Wang, Y X Zhao, H X Li, A J Li, S Liu, H M Chen, W Z Cui
Objective: To study the effects of heme oxygenase-1 transduced by cell penetrating peptide PEP-1 on renal injury in acute paraquat-induced rats. Methods: The fusion protein PEP-1/HO-1 was manufactured by genetic engineering methods. One hundred and twenty-six healthy adult Sprague-Dawley (SD) rats (63 male, 63 female) were randomly divided into three groups: (1) Control group: 42 rats, (2) Poisoned group: 42 rats, (3) PEP-1/HO-1 intervention group: 42 rats. The rats in Poisoned group and intervention group were treated intraperitoneally with paraquat (25 mg/kg) deliquated with normal saline...
September 20, 2016: Chinese Journal of Industrial Hygiene and Occupational Diseases
https://www.readbyqxmd.com/read/27866026/survival-and-cardiovascular-events-after-coarctation-repair-in-long-term-follow-up-coafu-predictive-value-of-clinical-variables
#19
P Bambul Heck, J Pabst von Ohain, H Kaemmerer, P Ewert, A Hager
OBJECTIVE: Long-term sequelae and events after coarctation repair are well described. However, the predictive value of variables from clinical follow-up investigation for late events and survival has rarely been investigated. METHODS: All patients who participated in the prospective cross-sectional COALA Study in 2000 with a structural clinical investigation including blood pressure measurement and symptom-limited exercise test were contacted for reevaluation of survival, current clinical status and major cardiovascular events...
November 9, 2016: International Journal of Cardiology
https://www.readbyqxmd.com/read/27858229/usefulness-of-three-dimensional-transesophageal-echocardiography-for-diagnosis-of-hemolytic-anemia-due-to-inverted-internal-felt-strip-after-surgery-for-aortic-dissection
#20
Takeshi Oda, Hiroshi Yasunaga, Yasuyuki Zaima, Akiko Arimura, Shinichi Imai, Ryo Kanamoto, Hayato Fukuda, Eiji Nakamura, Hideki Tashiro, Shigeaki Aoyagi
Felt strips are widely used for reinforcement of the aortic stump in surgery for aortic dissection (AD). Postoperative hemolytic anemia (HA) due to an inverted internal felt strip at the aortic stump fixation for AD is extremely rare. A 70-year-old woman underwent ascending aorta replacement for acute type A AD, where both proximal and distal anastomotic sites were reinforced with Teflon felt strips. A week later, macroscopic hematuria and HA emerged. Three-dimensional transesophageal echocardiography (3D-TEE) demonstrated that the proximal inner felt strip turned up and protruded into the aortic inner lumen...
November 17, 2016: Journal of Medical Ultrasonics
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