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Thoracic aneurysm

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https://www.readbyqxmd.com/read/27923483/regulation-of-membrane-type-1-matrix-metalloproteinase-activity-and-intracellular-localization-in-clinical-thoracic-aortic-aneurysms
#1
John S Ikonomidis, Elizabeth K Nadeau, Adam W Akerman, Robert E Stroud, Rupak Mukherjee, Jeffrey A Jones
OBJECTIVE: Membrane type-1 matrix metalloproteinase (MT1-MMP) is elevated during thoracic aortic aneurysm (TAA) development in mouse models, and plays an important role in the activation of matrix metalloproteinase (MMP)-2 and the release of matrix- bound transforming growth factor-β. In this study, we tested the hypothesis that MT1-MMP is subject to protein kinase C (PKC)-mediated regulation, which alters intracellular trafficking and activity with TAAs. METHODS: Levels of MMP-2, native and phosphorylated MT1-MMP, and PKC-δ were measured in aortic tissue from patients with small TAAs (<5 cm; n = 8) and large TAAs (>6...
November 14, 2016: Journal of Thoracic and Cardiovascular Surgery
https://www.readbyqxmd.com/read/27922338/pathophysiology-of-aortic-aneurysm-insights-from-human-genetics-and-mouse-models
#2
Nicole K Wilson, Russell A Gould, Elena Gallo MacFarlane, Mibava Leducq Consortium
Aneurysms are local dilations of an artery that predispose the vessel to sudden rupture. They are often asymptomatic and undiagnosed, resulting in a high mortality rate. The predisposition to develop thoracic aortic aneurysms is often genetically inherited and associated with syndromes affecting connective tissue homeostasis. This review discusses how elucidation of the genetic causes of syndromic forms of thoracic aortic aneurysm has helped identify pathways that contribute to disease progression, including those activated by TGF-β, angiotensin II and Notch ligands...
December 6, 2016: Pharmacogenomics
https://www.readbyqxmd.com/read/27921203/treatment-of-uncomplicated-type-b-aortic-dissection
#3
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/27919458/impact-of-preoperative-pulmonary-function-on-outcomes-after-open-repair-of-descending-and-thoracoabdominal-aortic-aneurysms
#4
Leonard N Girardi, Christopher Lau, Monica Munjal, Mohamed Elsayed, Ivancarmine Gambardella, Lucas B Ohmes, Mario Gaudino
OBJECTIVE: To evaluate the impact of preoperative pulmonary function on outcomes after open repair of descending thoracic (DTA) and thoracoabdominal aortic (TAAA) aneurysms. METHODS: The outcomes of patients undergoing open repair of DTA or TAAA were analyzed in relation to the results of preoperative pulmonary function tests. Receiver operating characteristic was adopted to assess the effect of forced expiratory volume in one second (FEV1) on the incidence of mortality...
November 10, 2016: Journal of Thoracic and Cardiovascular Surgery
https://www.readbyqxmd.com/read/27918318/alternative-treatment-for-residual-aortobronchial-fistula-after-thoracic-endovascular-aortic-repair
#5
Kosuke Ujihira, Yoshihiko Kurimoto, Ryushi Maruyama, Yutaka Iba, Naritomo Nishioka, Akira Yamada, Katsuhiko Nakanishi, Hiroaki Kato, Masaru Abe, Yoshiaki Narita, Masayuki Osawa
A patient with an aortobronchial fistula secondary to a thoracic endovascular aortic repair was successfully treated with a re-thoracic endovascular aortic repair with debranching technique. Five months postoperatively, the aneurysm had shrunk; however, computed tomography revealed air in the thrombo-excluded aortic aneurysmal sac without signs of infection. Because of worsening air finding at the eighth month, we performed a resection of the residual fistula and wrapped the stent graft in a pedicled muscle flap...
December 1, 2016: Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery
https://www.readbyqxmd.com/read/27916380/contemporary-outcomes-of-open-thoracoabdominal-aneurysm-repair-functional-status-is-the-strongest-predictor-of-perioperative-mortality
#6
Tammam Obeid, Caitlin W Hicks, Kanhua Yin, Isibor Arhuidese, Besma Nejim, Arman Kilic, James H Black, Mahmoud Malas
BACKGROUND: Open repair of thoracoabdominal and descending thoracic aneurysm (TAA) carries significant operative morbidity and mortality. Despite evolving operative techniques patient-level risk factors affecting mortality after open TAA repair, including patient functional status, remain to be fully understood. MATERIALS AND METHODS: We identified all open TAA repair cases in the National Surgical Quality Improvement Program database between 2005 and 2013. Multivariable logistic regression was used to evaluate the effect of patients' age, gender, race, body mass index (BMI), comorbid conditions, functional status, ASA class, smoking, rupture, descending thoracic aneurysm versus Crawford types, dissection, and preoperative: transfusion, creatinine levels, on perioperative (30-d) mortality after open TAA repair...
November 2016: Journal of Surgical Research
https://www.readbyqxmd.com/read/27914637/redo-thoracoabdominal-aortic-aneurysm-repair-a-single-center-experience-over-25%C3%A2-years
#7
Rana O Afifi, Harleen K Sandhu, Amy E Trott, Tom C Nguyen, Charles C Miller, Anthony L Estrera, Hazim J Safi
BACKGROUND: Aortic disease is a lifelong, progressive illness that may require repeated intervention over time. We reviewed our 25-year experience with open redo thoracoabdominal aortic aneurysm (TAAA) and descending thoracic aortic aneurysm (DTAA) repair. Our objectives were to determine patient outcomes after redo repair of DTAA/TAAA and compare them with nonredo repair. We also attempted to identify the risk factors for poor outcome. METHODS: We reviewed all open redo TAAA and DTAA repairs between 1991 and 2014...
November 30, 2016: Annals of Thoracic Surgery
https://www.readbyqxmd.com/read/27909281/-transaortic-thoracic-endovascular-aortic-repair-via-right-anterior-mini-thoracotomy-report-of-a-case
#8
Keitaro Okamoto, Tomoyuki Wada, Hirofumi Anai, Satoshi Takebayashi, Takashi Shuto, Takayuki Kawashima, Kazuki Mori, Norio Hongo, Noritaka Kamei, Hiromu Mori, Shinji Miyamoto
An 81-year-old man presented with ruptured thoracic aortic aneurysm under stable condition. He had been suffering from chronic obstructive pulmonary disease, chronic renal failure and rheumatoid arthritis. We performed hybrid thoracic endovascular aortic repair via right anterior mini-thoracotomy inserting a device through a conduit on the ascending aorta. The patient was discharged without aorta-related complications.
December 2016: Kyobu Geka. the Japanese Journal of Thoracic Surgery
https://www.readbyqxmd.com/read/27908818/ascending-aorta-to-hepatic-and-mesenteric-artery-bypassing-in-patients-with-chronic-mesenteric-ischaemia-and-extensive-aortic-disease-a-case-report-and-review-of-the-literature
#9
James Barr, John Kokotsakis, Pantelis Tsipas, Prodromos Papapavlou, Konstantinos Velissarios, Theodoros Kratimenos, Thanos Athanasiou
Chronic mesenteric ischaemia (CMI) is a rare disorder caused by severe stenosis of the mesenteric arterial supply that results in post prandial pain and weight loss. Treatment options are surgical or endovascular. Surgical bypass can be performed in an antegrade fashion from the supracoeliac abdominal aorta or the distal descending thoracic aorta or in a retrograde fashion from the infra-renal aorta or the common iliac artery. However in some patients with disease of the descending thoracic aorta (DTA) or the abdominal aorta (AA) another site for the proximal anastomosis needs to be found...
November 28, 2016: Annals of Vascular Surgery
https://www.readbyqxmd.com/read/27908813/coil-embolization-assisted-thoracic-endovascular-aortic-repair-for-multiple-saccular-descending-aortic-aneurysms-with-insufficient-landing-zone
#10
Akito Imai, Tomomi Nakajima, Masataka Sato, Yasunori Watanabe, Shunichi Kondo, Motoo Osaka, Yuji Hiramatsu
We report a coil embolization -assisted thoracic endovascular aortic repair technique successfully applied to multiple saccular descending aortic aneurysms in a 74-year-old man. Due to the most distal aneurysm being located at the celiac trunk level and the distance between the superior mesenteric artery and the aneurysm being only 10mm, a coil embolization of the distal saccular aneurysm was performed prior to stent delivery to secure a sufficient landing zone. Postoperative computed tomography showed an appropriate positioning of the endovascular devices without endoleak...
November 28, 2016: Annals of Vascular Surgery
https://www.readbyqxmd.com/read/27908810/emergent-treatment-of-a-ruptured-thoraco-abdominal-aortic-aneurysm-by-off-label-rescue-implantation-of-the-ovation-%C3%A2-stent-graft-in-nonagenarians-patient
#11
Chiara Pranteda, Pasqualino Sirignano, Federica Fornelli, Wassim Mansour, Nunzio Montelione, Laura Capoccia, Francesco Speziale
We report a case of a compassionate treatment of a ruptured thoraco-abdominal aortic aneurysm in a 92-year-old patient. Patient was admitted to our emergency department for acute onset of pain irradiating to the back. Computed tomographic angiography showed the presence of a thoraco-abdominal aortic aneurysm with a contained rupture at infrarenal level. Given of the presence of a relative healthy visceral aorta, we decided to treat the patient by Ovation(®) (Endologix, Irvine, CA - USA) implantation in an off-label fashion...
November 28, 2016: Annals of Vascular Surgery
https://www.readbyqxmd.com/read/27908809/a-combination-of-thoracic-and-abdominal-grafts-to-treat-an-abdominal-aortic-aneurysm-with-hostile-proximal-neck
#12
Mafalda Massara, Roberto Prunella, Pasquale Gerardi, Giovanni De Caridi, Raffaele Serra, Stefano Notarstefano, Giovanni Impedovo
Endovascular aneurysm repair (EVAR) actually represents the treatment of choice for most patients affected by aneurysm of the abdominal aorta (AAA). However, the feasibility of EVAR depends on anatomical characteristics of abdominal aorta and ilio-femoral axis. We present the case of a 82-years old man affected by severe left hydronephrosis, kidney and ureteral tumor requiring nephrectomy, that presented also a very voluminous AAA with a large diameter (96 mm), presenting also with a large proximal neck (39 mm) and with a severe angulation of the proximal neck (> 60°)...
November 28, 2016: Annals of Vascular Surgery
https://www.readbyqxmd.com/read/27908807/incomplete-expansion-of-chimney-stent-graft-during-chimney-thoracic-endovascular-aneurysm-repair-ch-tevar
#13
Athanasios Katsargyris, Domenico Spinelli, Kyriakos Oikonomou, Hozan Mufty, Eric Lg Verhoeven
PURPOSE: To report a technical complication during a chimney-thoracic endovascular aneurysm repair (Ch-TEVAR) procedure. CASE REPORT: A 77 year-old female patient underwent Ch-TEVAR for a symptomatic thoracic aortic aneurysm (TAA) with a short and angulated proximal neck. Deployment of the aortic stent-graft over the left subclavian artery (LSA) was followed by placement of a balloon expandable covered stent as a chimney for the LSA. Chimney deployment failed due to balloon perforation...
November 28, 2016: Annals of Vascular Surgery
https://www.readbyqxmd.com/read/27905691/is-volume-important-in-aneurysm-treatment-outcome
#14
Athanasios Katsargyris, Chris Klonaris, Eric L Verhoeven
Several studies have suggested that surgical procedures performed at high-volume centers may result in superior outcome. Technically more demanding procedures such as aortic aneurysm repair appear to demonstrate a stronger relationship with volume. The present chapter reviewed the literature using the MEDLINE database to identify studies investigating the effect of volume in aortic aneurysm repair outcomes. The great majority of studies identified shows an advantage for high-volume hospitals with regard to perioperative mortality of abdominal (AAA), thoracic (TAA) and thoracoabdominal (TAAA) aortic aneurysm repair...
December 1, 2016: Journal of Cardiovascular Surgery
https://www.readbyqxmd.com/read/27904826/infective-abdominal-aortitis-due-to-campylobacter-fetus-bacteremia-a-case-report-and-review-of-literature
#15
Abhinav Agrawal, Rutuja R Sikachi
Infectious aortitis (IA) is a rare but life-threatening condition, and most commonly affects the abdominal aorta or thoracic aorta. Various microorganisms have been associated with infectious thoracic aortitis, most commonly Staphylococcus, Enterococcus, Streptococcus, and Salmonella species. Campylobacter fetus (C. fetus) has been seen as a cause of infective aortitis only in a few case reports. We report a rare case of infective aortitis of the abdominal aorta caused due to C. fetus bacteremia. While C. fetus infections usually occur in patients with immunosuppression, such as malignancy, or those with diabetes mellitus, but our patient was not immunocompromised...
November 2016: Intractable & Rare Diseases Research
https://www.readbyqxmd.com/read/27903477/simultaneous-endovascular-repair-for-thoracic-and-abdominal-aortic-pathologies-early-and-mid-term-results
#16
Yuanyuan Guo, Hongbo Cai, Bin Yang, Hui Jin
OBJECTIVES: To analyse information from a single clinical centre, evaluating early and mid-term results of simultaneous thoracic endovascular aortic repair (TEVAR) and endovascular aneurysm repair (EVAR) for co-existing thoracic and abdominal aortic pathologies. METHODS: From January 2005 to December 2014, 13 patients (8 men, 5 women; mean age, 75.3 years, range, 69-82 years) with concomitant thoracic and abdominal aortic disease (aneurysms, type B dissection, penetrating aortic ulcers) were treated with simultaneous TEVAR and EVAR...
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
#17
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/27903475/technical-aspects-of-open-repair-for-degenerative-aneurysmal-evolution-despite-early-thoracic-endovascular-repair-of-type-b-aortic-dissection
#18
Sonia Aguir, Salma El Batti, Paul Achouh, Pierre Julia, Alain Bel, Jean-Noël Fabiani, Jean-Marc Alsac
: Closure of the proximal tear by Thoracic Endovascular Aortic Repair (TEVAR) at the acute phase appears to be an safe effective treatment to prevent aneurysmal degeneration type B dissection. However, it appears to be inefficient in up to a third of the patient. We report the technical aspects of our experience with patients undergoing secondary open repair after TEVAR for dissecting thoraco-abdominal aneurysm despite early closure proximal tear by TEVAR. METHODS: During a period of 5 years, 96 patients presenting acute Type B Aortic Dissections (TBAD) were treated by TEVAR and followed-up in our institution...
November 26, 2016: Annals of Vascular Surgery
https://www.readbyqxmd.com/read/27894713/abdominal-aortic-aneurysm-in-marfan-syndrome
#19
Tracy Hagerty, Patrick Geraghty, Alan C Braverman
OBJECTIVE: Marfan syndrome (MFS) leads to aortic root aneurysm, while descending thoracic aortic aneurysm (TAA) occurs less commonly. Abdominal aortic aneurysm (AAA) is rarely reported in MFS. Risk factors for AAA are poorly understood and there are no guidelines for AAA screening in MFS. We sought to characterize AAA among Marfan patients in our center. METHODS: The records of 12 adults with MFS and AAA disease were reviewed. Clinical features, imaging, operative reports, and outcomes were analyzed...
November 25, 2016: Annals of Vascular Surgery
https://www.readbyqxmd.com/read/27891504/thoracic-aorta-aneurysm-repair-in-a-patient-with-a-solitary-kidney-hybrid-surgery-as-a-bailout-procedure
#20
Chris Bakoyiannis, Demetrios Moris, George Karaolanis, Nikolaos Patelis, Dimitrios Schizas, Sotirios Georgopoulos, Theodoros Liakakos
Thoracic endovascular aortic repair (TEVAR) is an emerging treatment option for thoracic aorta aneurysms (TAA). Endovascular access is a challenge. We present a novel TEVAR technique in a patient with single kidney and a 6.4 cm TAA. Attempting to place a sheath through iliac arteries was unsuccessful. The decision to proceed to hybrid TEVAR was made. The protection of the solitary kidney was achieved through axillo-femoral bypass, followed by an end-to-side anastomosis between the aorta and a bifurcated graft...
2016: Frontiers in Surgery
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