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Thoracic aortic aneurysms and dissection

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https://www.readbyqxmd.com/read/29780894/multiple-re-entry-closures-after-tevar-for-ruptured-chronic-post-dissection-thoraco-abdominal-aortic-aneurysm
#1
R Kinoshita, F Ganaha, J Ito, N Ohyama, N Abe, T Yamazato, H Munakata, K Mabuni, T Kugai
Introduction: Although thoracic endovascular aortic repair (TEVAR) has become a promising treatment for complicated acute type B dissection, its role in treating chronic post-dissection thoraco-abdominal aortic aneurysm (TAA) is still limited owing to persistent retrograde flow into the false lumen (FL) through abdominal or iliac re-entry tears. Report: A case of chronic post-dissection TAA treatment, in which a dilated descending FL ruptured into the left thorax, is described...
2018: EJVES Short Reports
https://www.readbyqxmd.com/read/29780721/type-b-aortic-dissection-new-perspectives
#2
REVIEW
Marc A A M Schepens
Background: Stanford type B aortic dissection is one of the aortic catastrophes with a high mortality and morbidity that needs immediate or delayed treatment, either surgically or endovascularly. This comprehensive review article addresses the current status of open, endovascular and hybrid treatment options for type B aortic dissections with the focus on new therapeutic perspectives. Methods: Evaluation of currently available evidence based on randomized and registry data and personal experience...
2018: Journal of Visualized Surgery
https://www.readbyqxmd.com/read/29780714/how-can-genetic-diagnosis-inform-the-decision-of-when-to-operate
#3
REVIEW
Maral Ouzounian, Scott A LeMaire
Genetic discovery for heritable thoracic aortic disease (HTAD) has been progressing at a brisk pace. Surgical management of thoracic aortic aneurysms and dissections has become more personalized, with genetic factors increasingly informing the decision of when to operate on patients. An improved understanding of genotype-phenotype correlations in patients with HTAD will ultimately lead to gene- and mutation-specific recommendations for surgical repair. Until more robust data from larger cohorts can inform our decisions, patients with HTAD should be seen by an aortic specialist for a tailored approach to elective surgical repair...
2018: Journal of Visualized Surgery
https://www.readbyqxmd.com/read/29755088/-hybrid-repair-of-distal-arch-aortic-aneurysm-total-aortic-arch-repair-with-the-lupiae-vascular-graft-and-thoracic-endovascular-aortic-repair-report-of-two-cases
#4
Nobu Yokoyama, Daigo Shinoda, Mitsunori Nakano, Manabu Shiraishi, Satoshi Itoh
Surgical treatment for distal arch aortic aneurysm is generally invasive, and there is no definitive approach for it. We report 2 cases of men who was admitted for the treatment of aortic aneurysm. First case is a 78-year-old man. Two saccular aneurysm were observed on distal aortic arch and descending aorta by contrast-enhanced computed tomography. Two staged-repair was performed with using the Lupiae vascular graft and thoracic endovascular aortic repair(TEVAR). The postoperative course was uneventful, and he was discharged on day 21 after 1st operation...
May 2018: Kyobu Geka. the Japanese Journal of Thoracic Surgery
https://www.readbyqxmd.com/read/29755087/-successful-echo-guided-deployment-of-stent-graft-for-intraoperative-retrograde-aortic-dissection-and-rupture-report-of-a-case
#5
Naoki Kanemitsu, Takehiko Matsuo, Hiroaki Osada, Kazuo Yamanaka, Junichi Tazaki
We report a case of chronic dissecting thoracoabdominal aneurysm with intraoperative retrograde aortic dissection and rupture at proximal descending aorta, which was successfully treated by echoguided stent-graft insertion. An 82-year old male underwent thoracoabdominal aortic replacement for dilatation of infra-diaphragmatic aorta. Under F-F bypass, his thoracoabdominal aorta was replaced by a Dacron graft with 4-branches. After he weaned from F-F bypass, we found massive bleeding from proximal descending aorta...
May 2018: Kyobu Geka. the Japanese Journal of Thoracic Surgery
https://www.readbyqxmd.com/read/29755086/-total-arch-replacement-with-concomitant-thoracic-endovascular-aortic-repair-via-the-ascending-aorta-for-extended-thoracic-aneurysm-report-of-a-case
#6
Yoshiki Endo, Yoshihito Irie, Kousuke Nishida, Tsuyoshi Fujimiya, Yoshiaki Katada
The patient was a 66 year-old male. Computed tomography (CT) angiography showed a huge aneurysm(120 mm) in the aortic arch and chronic type B aortic dissection(45 mm) in the descending aorta. Echocardiography showed patent ductus arteriosus( PDA). Because of pulmonary hypertension due to PDA, it was considered unacceptable to put him under general anesthesia twice. We performed thoracic endovascular aortic repair (TEVAR) via the ascending aorta and total arch replacement (TAR) simultaneously to prevent paraplegia...
May 2018: Kyobu Geka. the Japanese Journal of Thoracic Surgery
https://www.readbyqxmd.com/read/29753564/left-atrium-and-pulmonary-artery-compression-due-to-aortic-aneurysm-causing-heart-failure-symptoms
#7
Antonio José Lagoeiro Jorge, Wolney de Andrade Martins, Victor M Moutinho, Juliano M Rezende, Patricia Y Alves, Humberto Villacorta, Pedro F Silveira, Antonio A Couto
Patients with thoracic aortic aneurysm (TAA) are mostly asymptomatic and TAA is rarely related to heart failure (HF). We report the case of an 80-year-old female patient, with type A TAA without dissection, with right pulmonary artery and left atrium compression, who presented with HF, preserved ejection fraction and acute pulmonary edema.
May 9, 2018: Portuguese Journal of Cardiology: An Official Journal of the Portuguese Society of Cardiology
https://www.readbyqxmd.com/read/29749581/preconception-counseling-for-patients-with-thoracic-aortic-aneurysms
#8
REVIEW
Prashant Rao, Eric M Isselbacher
PURPOSE OF THE REVIEW: Acute aortic dissection is a potentially catastrophic cardiovascular emergency that is associated with a high mortality rate. Pregnancy, with its attendant hormonal and physiological changes, increases the risk of dissection in women with known thoracic aortic aneurysms. In this review, we highlight the importance of preconception counseling to help women with known thoracic aortic aneurysms better understand their risk of dissection and the heritable nature of thoracic aortic disease and its associated syndromes...
May 10, 2018: Current Treatment Options in Cardiovascular Medicine
https://www.readbyqxmd.com/read/29748101/results-from-the-study-to-assess-outcomes-after-endovascular-repair-for-multiple-thoracic-aortic-diseases-summit
#9
Nikolaos Tsilimparis, Sebastian Debus, Min Chen, Qing Zhou, Mary-Margaret Seale, Tilo Kölbel
OBJECTIVE: Thoracic endovascular aortic repair (TEVAR) is currently the treatment of choice for most diseases of the descending thoracic aorta. Using data from the Study to Assess Outcomes After Endovascular Repair for Multiple Thoracic Aortic Diseases (SUMMIT) study we investigated the outcomes of TEVAR for different aortic diseases and risk factors associated with the outcomes. METHODS: The SUMMIT study included aggregated data of 521 TEVAR patients from five Cook-sponsored multicenter trials evaluating thoracic endografts of the Zenith platform (William Cook Europe, ApS, Bjaeverskov, Denmark)...
May 7, 2018: Journal of Vascular Surgery
https://www.readbyqxmd.com/read/29717556/heart-failure-and-sudden-cardiac-death-in-heritable-thoracic-aortic-disease-caused-by-pathogenic-variants-in-the-smad3-gene
#10
Julie De Backer, Alan C Braverman
BACKGROUND: Predominant cardiovascular manifestations in the spectrum of Heritable Thoracic Aortic Disease include by default aortic root aneurysms- and dissections, which may be associated with aortic valve disease. Mitral- and tricuspid valve prolapse are other commonly recognized features. Myocardial disease, characterized by heart failure and/or malignant arrhythmias has been reported in humans and in animal models harboring pathogenic variants in the Fibrillin1 gene. METHODS: Description of clinical history of three cases from one family in Ghent (Belgium) and one family in St...
May 1, 2018: Molecular Genetics & Genomic Medicine
https://www.readbyqxmd.com/read/29715704/benefits-and-risks-of-prophylactic-cerebrospinal-fluid-catheter-and-evoked-potential-monitoring-in-symptomatic-spinal-cord-ischemia-low-risk-thoracic-endovascular-aortic-repair
#11
Sven Maier, Maria Shcherbakova, Friedhelm Beyersdorf, Christoph Benk, Fabian Alexander Kari, Matthias Siepe, Martin Czerny, Bartosz Rylski
BACKGROUND:  To assess risks and benefits of a standardized strategy to prevent symptomatic spinal cord ischemia (SSCI) after thoracic endovascular repair (TEVAR) using routine cerebrospinal fluid (CSF) catheter placement and evoked potential (EP) monitoring. METHODS:  One hundred and ninety-five patients underwent 223 SSCI low-risk TEVAR procedures between 1998 and 2014. CSF catheter was used to measure CSF pressure and drain CSF if necessary throughout the procedure and up to 24 hours thereafter...
May 1, 2018: Thoracic and Cardiovascular Surgeon
https://www.readbyqxmd.com/read/29709360/the-fate-of-the-abdominal-aorta-after-endovascular-treatment-in-chronic-debakey-iiib-aneurysm
#12
Tae-Hoon Kim, Suk-Won Song, Kwang-Hun Lee, Min-Young Baek, Kyung-Jong Yoo, Hye Sun Lee
OBJECTIVES: We sought to identify the risk factors for abdominal aortic remodeling after thoracic endovascular aortic repair in patients with chronic DeBakey IIIb aneurysm. METHODS: From 2012 to 2016, 70 patients underwent thoracic endovascular aortic repair for chronic DeBakey IIIb aneurysm. The abdominal aortic diameter was measured at 3 different levels (celiac trunk, renal artery, and infrarenal aorta). Abdominal aorta status was classified as expansion or stable...
April 4, 2018: Journal of Thoracic and Cardiovascular Surgery
https://www.readbyqxmd.com/read/29708037/thoracic-endovascular-aortic-repair-to-treat-uncomplicated-stanford-type-b-aortic-dissection-the-surgeon-s-dilemma-to-preventing-future-complications
#13
Piergiorgio Tozzi
Uncomplicated type B aortic dissections have traditionally been managed non-operatively with aggressive blood pressure control. However, the best medical treatment is associated with a considerable risk of disease progression to complicated dissection or aneurysmal degeneration of the affected aortic segment. Thoracic endovascular aortic repair could prevent long-term complications but, because the dissected aorta is vulnerable, it is a high-risk procedure performed in asymptomatic patient. Therefore, endovascular treatment is not a solution for all patients and it should be performed only in the subgroup prone to developing progression of the disease and future complications...
June 2018: European Journal of Preventive Cardiology
https://www.readbyqxmd.com/read/29708033/the-role-of-genetic-testing-in-the-prevention-of-acute-aortic-dissection
#14
Davide Carino, Andrea Agostinelli, Alberto Molardi, Filippo Benassi, Tiziano Gherli, Francesco Nicolini
Although much has been learned about disease of the thoracic aorta, most diagnosis of thoracic aortic aneurysm (TAA) is still incidental. The importance of the genetic aspects in thoracic aortic disease is overwhelming, and today different mutations which cause TAA or alter its natural history have been discovered. Technological advance has made available testing which detects genetic mutations linked to TAA. This article analyses the genetic aspects of TAA and describes the possible role of genetic tests in the clinical setting in preventing devastating complications of TAA...
June 2018: European Journal of Preventive Cardiology
https://www.readbyqxmd.com/read/29705559/open-thoracic-and-thoraco-abdominal-aortic-repair-after-prior-endovascular-therapy
#15
Paula R Keschenau, Shirley Ketting, Barend Mees, Mohammad E Barbati, Jochen Grommes, Alexander Gombert, Geert Willem H Schurink, Drosos Kotelis, Michael J Jacobs
OBJECTIVE: The aim was to present current results of open thoracic and thoraco-abdominal aortic repair as secondary procedure after prior endovascular therapy. METHODS: This was a retrospective cross border single centre study. From 2006 to July 2017 45 open thoracic aortic (TAA) or thoraco-abdominal aortic aneurysm (TAAA) operations were performed on 44 patients (median age 58 [15-80] years) as secondary surgery after previous endovascular therapy comprising TEVAR (n = 38; 86%), EVAR (n = 3; 7%), fenestrated EVAR (n = 1; 2%) and TEVAR plus EVAR (n = 1; 2%)...
April 25, 2018: European Journal of Vascular and Endovascular Surgery
https://www.readbyqxmd.com/read/29701403/hostile-thoracic-aortic-aneurysm-treated-by-fenestrated-thoracic-stentgraft-with-proximal-sealing-in-ishimaru-zone-0
#16
Joel Sousa, João Neves, Vicente Riambau, José Teixeira
INTRODUCTION: Thoracic endovascular aortic aneurysm repair (TEVAR) is an established treatment for thoracic aortic disease in both the acute and elective setting, with such a widespread use that almost 50% of all thoracic aortic surgery in Europe is performed by these means. Nonetheless, the feasibility of TEVAR is determined by several anatomic factors, and the suitability of the proximal and distal landing zones remain one of the main limitations to its use. The advent of custom-made thoracic stent grafts widened the endovascular options in some challenging anatomies...
July 2017: Revista Portuguesa de Cirurgia Cardio-torácica e Vascular
https://www.readbyqxmd.com/read/29701395/elective-2nd-stage-tevar-to-complete-frozen-elephant-trunk-in-the-surgical-correction-of-complex-multisegmental-pathology-of-the-thoracic-aorta
#17
Álvaro Laranjeira Santos, António Cruz Tomás, Daniela Varela-Afonso, Jorge Pinheiro Santos, José Fragata
INTRODUCTION: Classical conventional surgery to treat multi-segmental thoracic aortic disease in two operative stages, sternotomy and left thoracotomy, is associated with significant mortality and complications. The Frozen Elephant Trunk (FET) associated with an endovascular procedure (TEVAR) allows an extensible and simplified surgical approach of the descending and thoracoabdominal aorta without increasing the risk. METHODS: Retrospective study of 8 patients (pts), 5 males, mean age 67...
July 2017: Revista Portuguesa de Cirurgia Cardio-torácica e Vascular
https://www.readbyqxmd.com/read/29701386/simplified-technique-for-aortic-arch-replacement-in-patients-at-high-risk-for-frozen-elephant-trunk
#18
Álvaro Laranjeira Santos, António Cruz Tomás, Jorge Pinheiro Santos, Daniela Varela-Afonso, José Fragata
INTRODUCTION: Surgical approach of multisegmental pathology of the thoracic aorta, namely aortic arch / descending aorta is challenging. The Frozen Elephant Trunk (FET) has good results, with acceptable risk. However, in the subgroup of patients (pts) older than 75 years and with important comorbidities, the surgical risk is very high. OBJECTIVES: Review short-term results of this original, simplified and potentially hybrid technique developed in our Department for this subgroup of patients...
July 2017: Revista Portuguesa de Cirurgia Cardio-torácica e Vascular
https://www.readbyqxmd.com/read/29701382/institutional-protocol-for-prevention-of-tevar-related-spinal-cord-ischemia-the-first-9-cases
#19
Marina Dias-Neto, Pedro Reis, Leonor Mendes, Margarida Rodrigues, Cristina Amaral, Graça Afonso, José Fernando Teixeira
INTRODUCTION: Spinal cord ischemia (SCI) is a feared complication after endovascular correction of thoracic aortic diseases (TEVAR). The guidelines of the European Society for Vascular Surgery recommend prophylactic lumbar drainage (LD) of cerebrospinal fluid in high-risk patients undergoing TEVAR. Our institutional protocol considers as high-risk patients as: coverage of the origin of the Adamkiewicz artery (T9-T12), aortic coverage >15 cm, involvement of collaterals (treated or untreated abdominal aortic aneurysm, left subclavian artery revascularization or bilateral occlusion of the internal iliac arteries) and symptomatic SCI...
July 2017: Revista Portuguesa de Cirurgia Cardio-torácica e Vascular
https://www.readbyqxmd.com/read/29701360/tevar-a-primary-or-adjunct-procedure-helpful-in-the-surgical-correction-of-complex-pathology-of-the-thoracic-aorta
#20
António Cruz Tomás, Álvaro Laranjeira Santos, Jorge Pinheiro Santos, Daniela Varela-Afonso, José Fragata
INTRODUCTION: Thoracic Endovascular Aortic Repair (TEVAR) made possible the treatment of aortic disease that previously could only be approached openly, associated with a considerable morbidity and mortality. However, it also brings new challenges influencing patient selection - favourable landing zone, good peripheral access, propensity for endoleak (EL) - that requires rigorous clinical and imaging follow- -up. OBJECTIVE: Review all patients that underwent TEVAR in our Department and assess morbidity and mortality...
July 2017: Revista Portuguesa de Cirurgia Cardio-torácica e Vascular
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