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Thoracic aortic aneurysms and dissection

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https://www.readbyqxmd.com/read/28433350/open-repair-of-chronic-thoracic-and-thoracoabdominal-aortic-dissection-using-deep-hypothermia-and-circulatory-arrest
#1
Joel Corvera, Hannah Copeland, David Blitzer, Adam Hicks, Joshua Manghelli, Philip Hess, John Fehrenbacher
BACKGROUND: Chronic dissection of the thoracic and thoracoabdominal aorta as sequela of a prior type A or B dissection is a challenging problem that requires close radiographic surveillance and prompt operative intervention in the presence of symptoms or aneurysm formation. Open repair of chronic thoracic and thoracoabdominal aortic dissection using deep hypothermia has been our preferred method to treat this complex pathology. The advantages of this technique include organ and spinal cord protection, the flexibility to extend the repair proximally into the arch, and the ability to limit ischemia to all vascular beds...
March 18, 2017: Journal of Thoracic and Cardiovascular Surgery
https://www.readbyqxmd.com/read/28432073/in-situ-laser-fenestration-is-a-feasible-method-for-revascularization-of-aortic-arch-during-thoracic-endovascular-aortic-repair
#2
Jinbao Qin, Zhen Zhao, Ruihua Wang, Kaichuang Ye, Weimin Li, Xiaobing Liu, Guang Liu, Chaoyi Cui, Huihua Shi, Zhiyou Peng, Fukang Yuan, Xinrui Yang, Min Lu, Xintian Huang, Mier Jiang, Xin Wang, Minyi Yin, Xinwu Lu
BACKGROUND: Reconstruction of the aortic major branches during thoracic endovascular aortic repair is complicated because of the complex anatomic configuration and variation of the aortic arch. In situ laser fenestration has shown great potential for the revascularization of aortic branches. This study aims to evaluate the feasibility, effectiveness, and safety of in situ laser fenestration on the three branches of the aortic arch during thoracic endovascular aortic repair. METHODS AND RESULTS: Before clinical application, the polytetrafluoroethylene and Dacron grafts were fenestrated by an 810-nm laser system ex vivo, which did not damage the bare metal portion of the endografts and created a clean fenestration while maintaining the integrity of the endografts...
April 21, 2017: Journal of the American Heart Association
https://www.readbyqxmd.com/read/28428528/-challenge-of-treating-thoracoabdominal-aortic-aneurysms-with-hybrid-thoracic-endovascular-aortic-repair
#3
Takashi Shuto, Shinji Miyamoto
The treatment of thoracoabdominal aortic aneurysms in great vessels is still challenging, as the early results of the operation are not very promising compared with other aortic operations, and the incidence of spinal cord ischemia is relatively high. In Japan, which is becoming a super-aging society, the method of performing minimally invasive operations remains a major issue. At our facility, we have been performing abdominal debranching thoracic endovascular aortic repair (TEVAR) to resolve these issues...
April 2017: Kyobu Geka. the Japanese Journal of Thoracic Surgery
https://www.readbyqxmd.com/read/28428526/-strategy-of-thoracic-endovascular-aortic-repair-for-uncomplicated-type-b-aortic-dissection-in-subacute-and-chronic-phase-interval-from-onset-and-maximum-diameter
#4
Masatoshi Sunada, Kyohei Ueno, Rie Kageyama, Satoru Maeba, Hirofumi Midorikawa, Megumu Kanno
We classified 59 patients who underwent thoracic endovascular aortic repair for uncomplicated type B aortic dissection from April 2008 to April 2016 into 3 groups based on time from onset and maximum aortic diameter:SA (2weeks to 1 year since onset;n=29), C (>1 year since onset;n=17), and D(maximum aneurysm size≥60 mm;n=13). We used the Kaplan-Meier method tso analyze survival, major adverse cardiovascular event and the need for additional treatment. There was no significant difference in outcomes between the SA and C groups (p=0...
April 2017: Kyobu Geka. the Japanese Journal of Thoracic Surgery
https://www.readbyqxmd.com/read/28428523/-efficacy-of-total-debranching-thoracic-endovascular-aortic-repair-for-the-re-operation-of-aortic-arch-aneurysm
#5
Kyohei Ueno, Megumu Kanno, Hirofumi Midorikawa, Gaku Takinami, Rie Kageyama
Thoracic endovascular aortic repair (TEVAR) combined with all-neck-branch reconstruction (total debranching TEVAR)[td TEVAR] is applied to aortic arch aneurysms as a minimally invasive procedure to improve treatment results. We report the initial and long-term results of td TEVAR for the reoperation of aortic arch aneurysm. By September 2016, td TEVAR for reoperation had been applied in 5 cases. The reasons for the reoperation were dilation of the arch aneurysm after ascending aorta replacement in 4 cases and localized dissection of the proximal landing zone after zone 2 TEVAR in 1 case...
April 2017: Kyobu Geka. the Japanese Journal of Thoracic Surgery
https://www.readbyqxmd.com/read/28411526/endovascular-repair-of-a-ruptured-thoracic-aortic-dissection-with-a-right-sided-aortic-arch-a-case-report
#6
Jeremy L Irvan, James R Elmore, Sarah L Flora, Evan J Ryer
BACKGROUND: Emergency treatment of complex aortic pathology is challenging in the setting of a right-sided aortic arch. We report the successful treatment of a ruptured thoracic aortic aneurysm (TAA) in the setting of a Stanford type B aortic dissection (TBAD) and right-sided aortic arch. PRESENTATION OF CASE: The patient is a 66-year-old male with chronic kidney disease (CKD) admitted with right sided chest pain and hypotension. Computed tomography angiography (CTA) revealed a 5cm ruptured TAA in the setting of a TBAD and right-sided aortic arch...
March 28, 2017: International Journal of Surgery Case Reports
https://www.readbyqxmd.com/read/28400556/precise-treatment-of-aortic-aneurysm-by-three-dimensional-printing-and-simulation-before-endovascular-intervention
#7
Ding Yuan, Han Luo, Hongliu Yang, Bin Huang, Jingqiang Zhu, Jichun Zhao
In this study, three-dimensional printing (3Dp) models and simulation surgeries (SSs) were applied in two challenging aortic cases. The first was an abdominal aortic aneurysm with a complex neck, and the second was a thoracic aortic dissection aneurysm (TADA) with an angled arch. In order to avoid unpredictable obstacles and difficulties, we made optimal surgical plans by using 3D models and virtual simulations. Based on preoperative evaluation system, the surgical plans seemed more reasonable and time-saving...
April 11, 2017: Scientific Reports
https://www.readbyqxmd.com/read/28400216/high-mortality-rates-after-both-open-surgical-and-endovascular-thoracic-aortic-interventions-in-patients-with-end-stage-renal-disease
#8
Nathan L Liang, Theodore H Yuo, Georges E Al-Khoury, Eric S Hager, Michel S Makaroun, Michael J Singh
BACKGROUND: Morbidity and mortality have improved with the evolution of endovascular techniques (thoracic endovascular aortic repair [TEVAR]) for thoracic aortic disease, but results after aortic intervention in patients with end-stage renal disease (ESRD) remain unclear. The objective of this study was to evaluate outcomes of open and endovascular descending thoracic aortic repair in dialysis-dependent patients. METHODS: We identified 352 patients with ESRD on dialysis undergoing open repair (n = 136) or TEVAR (n = 216) of the thoracic aorta from 2005 to 2008 using the United States Renal Data System database...
April 8, 2017: Journal of Vascular Surgery
https://www.readbyqxmd.com/read/28398537/intima-migration-from-the-iliac-artery-to-a-debranched-graft-after-thoracic-endovascular-aortic-repair
#9
Kazuki Kihara, Miwa Tashiro, Hideaki Nishimori, Kazumasa Orihashi
An 84-year-old woman underwent single-debranched thoracic endovascular aortic repair for aortic aneurysm. A few hours later, malperfusion of the left upper extremity occurred. Surgical exploration revealed a tubular-shaped intima packed in the debranched graft. As computed tomography showed localized dissection in the right external iliac artery probably due to access route injury, the intima roll was thought to have migrated from the iliac artery. This extremely rare case is described in detail with a discussion of the potential mechanism...
April 6, 2017: Interactive Cardiovascular and Thoracic Surgery
https://www.readbyqxmd.com/read/28391405/postmortem-genetic-testing-should-be-recommended-in-sudden-cardiac-death-cases-due-to-thoracic-aortic-dissection
#10
Marina Gago-Díaz, Eva Ramos-Luis, Silvia Zoppis, Esther Zorio, Pilar Molina, Aitana Braza-Boïls, Juan Giner, Beatriz Sobrino, Jorge Amigo, Alejandro Blanco-Verea, Ángel Carracedo, María Brion
BACKGROUND: Acute thoracic aortic dissections and ruptures, the main life-threatening complications of the corresponding aneurysms, are an important cause of sudden cardiac death. Despite the usefulness of the molecular diagnosis of these conditions in the clinical setting, the corresponding forensic field remains largely unexplored. The main goal of this study was to explore and validate a new massive parallel sequencing candidate gene​ assay as a diagnostic tool for acute thoracic aortic dissection autopsy cases...
April 8, 2017: International Journal of Legal Medicine
https://www.readbyqxmd.com/read/28390917/thoracic-endovascular-aortic-repair-into-the-false-lumen-in-chronic-aortic-dissection
#11
Arnoud V Kamman, David M Williams, Himanshu J Patel
PURPOSE: We present two different cases of chronic aortic dissection, where we opted to land the stent graft into the false lumen to treat the associated aneurysm. CASE DESCRIPTIONS: For the first case, the goal of thoracic endovascular aortic repair (TEVAR) was to exclude the aneurysm from within the false lumen, because of a slit-like true lumen. In the second case, the visceral arteries came off the false lumen, with the renal vessels from the true lumen. False lumen TEVAR was performed and the infra-renal aorta fenestrated, as to ensure adequate perfusion...
April 5, 2017: Annals of Vascular Surgery
https://www.readbyqxmd.com/read/28387611/thoracic-endovascular-aortic-repair-with-single-double-chimney-technique-for-aortic-arch-pathologies
#12
Tun Wang, Chang Shu, Ming Li, Quan-Ming Li, Xin Li, Jian Qiu, Kun Fang, Alan Dardik, Chen-Zi Yang
PURPOSE: To summarize a single-center experience using the single/double chimney technique in association with thoracic endovascular aortic repairs (TEVAR) for aortic arch pathologies. METHODS: From November 2007 to March 2016, 122 patients (mean age 50.4±12.7 years, range 29-80; 92 men) with aortic arch pathologies underwent TEVAR combined with single (n=101) or double (n=21) chimney grafts to reconstruct the supra-aortic branches: 21 innominate arteries, 114 left common carotid arteries, and 8 left subclavian arteries (LSA)...
March 1, 2017: Journal of Endovascular Therapy
https://www.readbyqxmd.com/read/28377913/acute-type-b-aortic-dissection-in-a-patient-with-previous-endovascular-abdominal-aortic-aneurysm-repair
#13
Sung Hun Park, Seung-Woon Rha
Endovascular aortic repair (EVAR) was relatively safe, and became a widely performed procedure. If aortic dissection (AD) occurred in patient with previous EVAR, it could cause fatal complications like endograft collapse. Surgical treatment was limited in this situation for comorbidities and complex anatomies. Here we report a rare case of acute type B AD developed following trans-radial coronary intervention in a patient with previous EVAR of abdominal aortic aneurysm, which was treated with thoracic EVAR.
March 2017: Vascular Specialist International
https://www.readbyqxmd.com/read/28356339/nicotinamide-phosphoribosyltransferase-in-smooth-muscle-cells-maintains-genome-integrity-resists-aortic-medial-degeneration-and-is-suppressed-in-human-thoracic-aortic-aneurysm-disease
#14
Alanna Watson, Zengxuan Nong, Hao Yin, Caroline O'Neil, Stephanie Fox, Brittany Balint, Ray Guo, Oberdan Leo, Michael W Chu, Robert Gros, J G Pickering
Rationale: The thoracic aortic wall can degenerate over time with catastrophic consequences. Vascular smooth muscle cells (SMCs) can resist and repair artery damage but their capacities decline with age and stress. Recently, cellular production of NAD(+) via nicotinamide phosphoribosyltransferase (Nampt) has emerged as a mediator of cell vitality. However, a role for Nampt in aortic SMCs in vivo is unknown. Objective: To determine if a Nampt-NAD(+) control system exists within the aortic media and is required for aortic health...
March 29, 2017: Circulation Research
https://www.readbyqxmd.com/read/28355763/-late-reoperations-after-repaired-stanford-type-a-aortic-dissection
#15
F H Huang, L P Li, C H Su, W Qin, M Xu, L M Wang, Y S Jiang, Z B Qiu, L Q Xiao, C Zhang, H W Shi, X Chen
Objective: To summarize the experience of reoperations on patients who had late complications related to previous aortic surgery for Stanford type A dissection. Methods: From August 2008 to October 2016, 14 patients (10 male and 4 female patients) who underwent previous cardiac surgery for Stanford type A aortic dissection accepted reoperations on the late complications at Department of Thoracic and Cardiovascular Surgery, Nanjing Hospital Affiliated to Nanjing Medical University. The range of age was from 41 to 76 years, the mean age was (57±12) years...
April 1, 2017: Zhonghua Wai Ke za Zhi [Chinese Journal of Surgery]
https://www.readbyqxmd.com/read/28342521/endovascular-management-of-chronic-symptomatic-aortic-dissection-with-the-streamliner-multilayer-flow-modulator-twelve-month-outcomes-from-the-global-registry
#16
Sherif Sultan, Edel P Kavanagh, Florian Stefanov, Mohamed Sultan, Ala Elhelali, Victor Costache, Edward Diethrich, Niamh Hynes
OBJECTIVE: Reported are initial 12-month outcomes of patients with chronic symptomatic aortic dissection managed by the Streamliner Multilayer Flow Modulator (SMFM; Cardiatis, Isnes, Belgium). Primary end points were freedom from rupture- and aortic-related death, and reduction in false lumen index. Secondary end points were patency of great vessels and visceral branches, and freedom of stroke, paraplegia, and renal failure. METHODS: Out of 876 SMFM implanted globally, we have knowledge of 542...
April 2017: Journal of Vascular Surgery
https://www.readbyqxmd.com/read/28341530/thoracic-endovascular-aortic-repair-for-type-b-acute-aortic-dissection-complicated-by-descending-thoracic-aneurysm
#17
G Piffaretti, P Ottavi, C Lomazzi, M Franchin, R Micheli, F Ferilli, W Dorigo, M Marrocco-Trischitta, P Castelli, S Trimarchi
OBJECTIVES: To analyse the results and review the literature about thoracic aortic endovascular repair (TEVAR) for type B acute aortic dissection (TBAAD) complicated by descending thoracic aortic aneurysm (DTA) in the hyperacute or acute phases. METHODS: This was a multicentre, observational descriptive study. Inclusion criteria were TBAAD with a DTA of ≥50 mm, TBAAD on an already known aneurysmal descending thoracic aorta, and TBAAD presenting with an enlarged aorta with a total diameter <50 mm, but with >50% diameter increase compared with a previous computed tomography angiography (CTA) showing a non-dissected aorta with normal sizing...
March 22, 2017: European Journal of Vascular and Endovascular Surgery
https://www.readbyqxmd.com/read/28341507/endovascular-aortic-repair-for-progressive-chronic-thoracoabdominal-aortic-dissections
#18
Vito Mantese, Shameem Kunhammed
BACKGROUND: Ascending and thoracic aortic dissections progress into thoracoabdominal aneurysms 20-40% of the time, due to the initial aortic injury with associated weakness of the aortic wall. The increased firmness of the intimal flap usually results in a collapsed true lumen that does not spontaneously re-expand even with progressive dilatation of the aorta. In an effort to identify a safe and effective treatment path for this complex disease process, we present 4 cases illustrating successful sequential thoracic endovascular aortic repair (TEVAR) and fenestrated endovascular aortic repair (FEVAR)...
March 21, 2017: Annals of Vascular Surgery
https://www.readbyqxmd.com/read/28322037/analysis-of-klk1-polymorphism-rs5516-in-patients-with-abdominal-aortic-aneurysm-or-thoracic-aortic-dissection
#19
Yiming Zhang, Hongliang Huang, Yuliang Ma, Yifeng Sun, Guohua Wang, Liming Tang
No abstract text is available yet for this article.
March 20, 2017: Journal of Cardiovascular Surgery
https://www.readbyqxmd.com/read/28288887/transapical-endovascular-repair-of-thoracic-aortic-pathology
#20
Takashi Murakami, Shinsuke Nishimura, Mitsuharu Hosono, Yoshitsugu Nakamura, Etsuji Sohgawa, Yukimasa Sakai, Toshihiko Shibata
BACKGROUND: Alternative access for thoracic endovascular aortic repair (TEVAR) has been explored for patients with unsuitable femoral and iliac access, but few cases of transapical access have been described. We report our experience with transapical access for various aortic pathologies. METHODS: We reviewed 6 cases undergoing transapical access for endovascular repair of thoracic aortic pathology between December 2013 and August 2015. Five patients had an aortic arch aneurysm and 1 patient presented with Stanford type A subacute aortic dissection...
March 10, 2017: Annals of Vascular Surgery
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