TY - JOUR. T1 - Outcome of medical and surgical treatment in patients with acute type B aortic dissection. AU - Hsu, Ron Bin. AU - Ho, Yi Lwun. AU - Chen, Robert J.. AU - Wang, Shoei Shen. AU - Lin, Fang Yue. AU - Chu, Shu Hsun. PY - 2005/1/1. Y1 - 2005/1/1. N2 - Background. Optimal treatment of acute type B aortic dissection remain unclear. The aim of this study was to assess the clinical outcome of acute type B aortic dissection. Methods. In the last 8 years, 107 patients were admitted for acute type B aortic dissection. We medically treated patients at the time of onset with antihypertensives. Surgery was considered if there is intractable pain, uncontrolled hypertension, severe aortic branch malperfusion, or aneurysm expansion. Results. Twenty-nine patients had pleural effusion (27%), 9 patients had leg ischemia (8%), 5 patients had impending rupture, and 2 patients had aneurysm enlargement exceeding 60 mm on repeated imaging studies. A total of 16 patients (15%) underwent surgical ...
The optimal treatment for patients with type B aortic dissection remains a matter of debate. Each cardiologist or surgeon determines the surgical indications for type B aortic dissection according to his or her experience and the surgical results of the institution.. Recently, however, it was advocated that patients who had type B acute aortic dissection without complications, such as rupture or organ ischemia, be treated with hypotensive drugs during the acute phase, because the mortality rate with this treatment is reported to be equal to or slightly better than that for surgical treatment during the acute phase.4 5 12 13 14 15 16 17 Surgical treatment should be selected if the aortic diameter becomes enlarged during the chronic phase; careful observation of aortic enlargement in all patients treated during the chronic phase is very important but very difficult. Unfortunately, some patients who have successfully gone through the acute phase with medical hypotensive therapy suddenly die during ...
The suitable treatment strategy for acute descending aortic dissection has long been a matter of debate and continues to be a challenge [1]. High mortality rates in surgical treatment (25-50%) of complicated acute type B dissections, directed surgeons to search for other treatment modalities. Implementation of endovascular techniques has provided new therapeutic options [5]. Initial series and subsequent multicenter trials demonstrated technical feasibility and a low rate of complications even in high-risk patients with acute type B dissection.. However, treatment of acute aortic dissections by endovascular grafting itself carries some risks. Leakage can occur in approximately 25% of patients. Rarely, the stent graft may not plug the aortic wall adequate and may dislocate. In 8% of patients embolic material may originate from an atherosclerotic basis and corrupt the blood flow of the spinal cord, leading to paraplegia. There is furthermore the risk for abdominal malperfusion. In this situation ...
In this study, we provide a contemporary overview of clinical outcomes in patients with known MFS without prior aortic dissection. This represents one of the largest MFS studies to date using 3-dimensional imaging techniques. We found a type B aortic dissection rate of 9% during a median follow-up period of 6 years. Type B aortic dissections generally occurred in mildly dilated proximal descending aortas, especially in patients with prior prophylactic aortic surgery. From our data, we were able to develop a risk score to predict type B aortic dissection in patients with MFS, on the basis of history of prophylactic aortic root surgery and proximal descending aortic diameter.. The occurrence of type A aortic dissection has become a rare event in patients with known MFS in the era of aggressive prophylactic surgery. Although AoRR has improved life expectancy considerably, distal aortic disease may develop later in patients with MFS (14,15). Replacement of the aortic root or ascending aorta with a ...
In this study, we provide a contemporary overview of clinical outcomes in patients with known MFS without prior aortic dissection. This represents one of the largest MFS studies to date using 3-dimensional imaging techniques. We found a type B aortic dissection rate of 9% during a median follow-up period of 6 years. Type B aortic dissections generally occurred in mildly dilated proximal descending aortas, especially in patients with prior prophylactic aortic surgery. From our data, we were able to develop a risk score to predict type B aortic dissection in patients with MFS, on the basis of history of prophylactic aortic root surgery and proximal descending aortic diameter.. The occurrence of type A aortic dissection has become a rare event in patients with known MFS in the era of aggressive prophylactic surgery. Although AoRR has improved life expectancy considerably, distal aortic disease may develop later in patients with MFS (14,15). Replacement of the aortic root or ascending aorta with a ...
Ruptured type B acute aortic dissection iAAD jis a life-threatening condition, in which surgical treatment most often yields unsatisfactory results. We report a case of a ruptured type B AAD in a 67-year-old man detected on computed tomography that required a partial aortic arch replacement with reconstruction of the left subclavian artery with adjunct deep hypothermic circulatory arrest iDHCA). Although the patient had a postoperative stroke, he recovered markedly with rehabilitation. DHCA and open proximal anastomosis are useful for the surgical treatment of type B AAD, however, an elaborate strategy to prevent an intraoperative cerebral embolism is especially important ...
Spontaneous abdominal aortic dissection (AAD) with retrograde thoracic extension is an extremely rare occurrence with a high mortality. Abdominal aortic dissection can be associated with an abdominal aortic aneurysm (AAA) and the presence of an AAD w
Current management and outcome of chronic type B aortic dissection: results with open and endovascular repair since the advent of thoracic endografting
Current management and outcome of chronic type B aortic dissection: results with open and endovascular repair since the advent of thoracic endografting
Aortic dissection, though rare, is an often fatal event.1 A recent population-based study from Oxford showed that women have higher mortality from aortic dissection and are more likely to die before hospital assessment,2 which was also shown by the worlds largest registry of aortic dissection.3 Importantly, most individuals with aortic dissection had inadequately controlled hypertension, suggesting that modifiable risk factors may play a role in prevention.2 Moreover, women have worse outcomes following surgery for aortic dissection,3 and the surgical risk is even higher during pregnancy.4 ,5 The majority of aortic dissections in women of childbearing age occur during pregnancy and have adverse consequences for the mother and the fetus.6 Data from the Swedish National Birth Registry in women ,40 years of age have shown that pregnancy is associated with a 25-fold increased risk of aortic dissection.6 The scientific literature regarding aortic dissection and pregnancy is largely made up of case ...
BACKGROUND: Aortic dissection is a separation of the aortic wall, caused by blood flowing through a tear in the inner layer of the aorta. Aortic dissection is an infrequent but life-threatening condition. The incidence of aortic dissection is 3 to 6 per 10,000 per year in the Western population, and can be up to 43 per 10,000 per year in the Eastern population. Over 20% of people with an aortic dissection do not reach a hospital alive. After admission, the mortality rates for people with an aortic dissection are between 10% and 20% for those who received endovascular treatment, and between 20% and 30% for those who had open surgery. Thoracic endovascular aortic repair (TEVAR) is the standard endovascular method to treat complicated type B aortic dissection (aortic dissections without involvement of the ascending aorta). Although TEVAR is less invasive than open surgery and has a better long-term aortic remodeling effect than conservative medical treatment, favourable aortic remodelling is ...
OBJECTIVES The purpose of this study is to delineate changes in aortic geometry and diameter due to dissection. BACKGROUND Aortic diameter is the major criterion for elective ascending aortic replacement for dilated ascending aortas to prevent aortic dissection. However, recommendations are made on the basis of clinical experience and observation of diameters of previously dissected aortas. METHODS Six tertiary centers on 2 continents reviewed their acute aortic dissection type A databases, which contained 1,821 patients. Included were all non-Marfan patients with nonbicuspid aortic valves who had undergone computed tomography angiography ,2 years before and within 12 h after aortic dissection onset. Aortic geometry before and after dissection onset were compared. RESULTS Altogether, 63 patients were included (27 spontaneous and 36 retrograde dissections, median age 68 [57; 77] years; 54% were men). In all but 1 patient, maximum ascending aortic diameter was ,55 mm before aortic dissection ...
Introduction : Acute aortic type III dissection is one of the most catastrophic events, with in-hospital mortality ranging between 10% and 12%. The majority of patients are treated medically, but complicated dissections, which represent 15% to 20% of cases, require surgical or thoracic...
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Background. Complete resection of the intimal tear in aortic arch is one of the most complicated tasks in the treatment of aortic dissections. We introduced open stent grafting technique to complete this task with technical easiness. In this study we evaluated the long term efficacy of this procedure from our 12 years experience.. Patients and Method. Form January 1994 to December 2004, 59 aortic dissections with intimal tear in aortic arch or proximal descending aorta were operated with open stent grafting technique (age 61.7yrs, 41 type A and 18 type B). Thirty three (55.9%) were in emergency status. All these cases were morphologically excluded from the indication of transluminal endovascular repair. Under deep hypothermic circulatory arrest with antegrade cerebral perfusion, the hybrid prosthesis was inserted into descending aorta through the transected proximal aortic arch in order to achieve intimal tear exclusion.. Results. Complete exclusion of the aortic arch intimal tear was achieved ...
Objective: To report on the technical eligibility of patients previously treated for Stanford type A aorta dissection (AAD) for endovascular aortic arch repair based on contemporary anatomical criteria for an arch inner-branched stentgraft (AIBS). Methods: All patients treated for AAD from 2004-2015 at a single aortic centre were identified. Extent of repair and use of circulatory arrest were reported. Survival and reoperation were assessed using Kaplan Meier and competing risk models. Anatomic assessment was performed using 3-dimensional CT-imaging software. Primary outcome was survival ≥ 1 year and fulfilment of the AIBS anatomical criteria. Results: A total of 198 patients were included (158 Debakey I, 32 Debakey II, and 8 Intramural hematoma). Mortality was 30-days: 16.2%, 1-year: 19.2%, 10-years: 45.0%. There were 129 patients with imaging beyond 1 year (mean, 47.8 months), while 89 (69.0%) were AIBS eligible. During follow-up, 19 (14.7%) patients met the threshold criteria for aortic ...
7/11|br />18:50-21:10 Aortic Dissections/ Transection/ Trauma|br />Πρόεδροι: E. Brountzos,M. Khoury,F. Sigala,A. Trikas|br />18:50-19:00 Single stage hybrid repair for De Bakey type I aortic dissection|br /> . Tzilalis|br />19:00-19:10 Innominate artery dissection mimicking saccular aortic rupture|br />C. Kotoulas|br />19:10-19:20 Treatment of a type II post dissection TAAA with one renal artery originating from false lumen|br />T. Bisdas|br />19:20-19:30 Right axillary and left femoral artery perfusion for repair of posttraumatic aortic arch disruption|br />T. Karaiskos|br />19:30-19:40 Endovascular treatment of subacute type B thoracic dissection in a young patient|br />T. Kratimenos |br />19:40-19:50 Urgent endovascular repair of suprarenal aortic perforation during TAVI|br />S. Kalliafas|br />19:50-20:00 Valve sparing procedure (DAVID) in acute Type I Dissection|br />D. Iliopoulos|br />20:00-20:10 Left Carotid Cannulation for acute aortic dissection|br />V. Patris|br />20:10-20:20 Treatment
A 59-year-old man with a history of hypertension who suddenly developed back pain and apoplexy was transferred to our hospital 20 min after the clinical onset. Physical examination showed right conjugate deviation of the eyes and left paralysis, suggesting disorder of the right cerebral hemisphere. Enhance computed tomography showed an aortic dissection from the ascending aorta to bilateral iliac arteries, and the right common cranial artery was compressed by a false lumen. Acute type A aortic dissection complicated with cerebral malperfusion was diagnosed, and an emergency operation was performed 2.5h after the onset. Cardiopulmonary bypass was established with right femoral artery inflow and bicaval venous drainage. We found the dissection entry at the ascending aorta using the distal open technique, and performed hemiarch graft replacement with selective cerebral perfusion. The postoperative course was uneventful without deterioration of neurological function. Postoperative computed ...
Abdominal Pain & Pupillary Abnormality & Thoracic Aortic Dissection Symptom Checker: Possible causes include Thoracic Aortic Aneurysm. Check the full list of possible causes and conditions now! Talk to our Chatbot to narrow down your search.
This study evidences for the first time the arterial fragility of Col3a1 insufficient mice and their susceptibility to develop thoracic aortic dissections and ruptures in response to AngII. As observed in vEDS patients, in this AngII infusion model, Col3a1+/− mice died prematurely and significantly more when compared with Col3a1+/+ mice. The haploinsufficiency in type III collagen confers an important fragility to the thoracic aortic wall in response to rapid and important rises in SBP induced by a high-dose of AngII. In this model, BP seems to be a major trigger of this fragility since (1) early deceased Col3a1+/− mice had also the highest rises in SBP, and (2) lowering by half the dose of AngII and its associated increases in SBP (26 to 13 mm Hg) rescued the first-week premature deaths observed in Col3a1+/− mice. This is consistent with the contribution of collagen to the mechanical properties of the arterial wall and the preponderance of type III collagen in the media. However, NE ...
Present and future cardiothoracic intensivists will enjoy this talk by Brian Plunkett on thoracic aortic dissection given at Bedside Critical Care Conference 4.. ...
Friday, March 23, 2018 Herberman Conference Center at UPMC Cancer Pavilion, UPMC Shadyside Pittsburgh, Pa. 1 to 8 p.m.* *Times are Tentative Program Goal To provide oncology health care professionals with the knowledge and skills needed to promote evidence-based care to oncology patients and their families throughout the survivorship continuum. Who Should ...
Aortic dissection (AD) occurs when an injury to the innermost layer of the aorta allows blood to flow between the layers of the aortic wall, forcing the layers apart. In most cases this is associated with a sudden onset of severe chest or back pain, often described as "tearing" in character. Also, vomiting, sweating, and lightheadedness may occur. Other symptoms may result from decreased blood supply to other organs such as stroke or mesenteric ischemia. Aortic dissection can quickly lead to death from not enough blood flow to the heart or rupture of the aorta. Aortic dissection is more common in those with a history of high blood pressure, a number of connective tissue diseases that affect blood vessel wall strength such as Marfan syndrome, a bicuspid aortic valve, and previous heart surgery. Major trauma, smoking, cocaine use, pregnancy, a thoracic aortic aneurysm, inflammation of arteries, and abnormal lipid levels are also associated with an increased risk. The diagnosis is suspected based ...
Objectives At the conclusion of this educational activity, participants should be able to: Define aortic dissection Describe epidemiology of acute aortic dissection State common and uncommon presentations of acute aortic dissection Appreciate that a normal chest radiograph should not be used to rule out acute aortic dissection List three factors leading to a missed diagnosis of aortic dissection List key pitfalls in the management of acute aortic dissection 3
Methods In 11 patients with Stanford B aortic dissection, TEE and TTE were used to determine the parameters for pre-surgery diagnosis and selection of a coated stent. During surgery, TEE and TTE provided real-time and dynamic monitoring and guiding for precise implantation of the coated stent to effectively seal the tear of the aortic dissection. After surgery, clinical efficacy and potential side effects of the implantation of the coated stent were evaluated.. ...
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Acute type B aortic dissection is a potentially life-threatening condition that historically has been treated with either medical therapy or, when necessary, through invasive surgical techniques," explained Joseph Bavaria, professor of Surgery and director of the Thoracic Aortic Surgery Program, University of Pennsylvania, USA, and a national principal investigator for DISSECTION. DISSECTION results. Bavaria presented the results of the trial at the 2014 annual meeting of the Society for Thoracic Surgery. Twelve-month data from 50 patients evaluated in the trial demonstrate safety and efficacy of the Valiant Captivia System in the treatment of dissections, with excellent technical success.. Conducted at 16 US sites, the trial met its primary safety endpoint by achieving an 8% all-cause mortality rate at 30 days, which represents a three- to four-fold mortality improvement over open surgical repair. Additionally, 100% technical success and 100% coverage of the primary entry tear at implant were ...
Special Envoy to Pakistan and Afghanistan Richard Holbrooke died Monday at the age of 69 after suffering an aortic dissection, a small tear in the largest artery of the body. Aortic dissections are uncommon but often fatal, even when patients receive prompt medical attention.
A 65-year-old man presents to the emergency department with increasing back pain. His history includes hypertension, peripheral neuropathy, duodenal ulcer, superior mesenteric vein thrombus, stage IIB colon cancer treated with surgery and adjuvant chemotherapy, renal cell carcinoma treated with surgery, and prostate cancer treated with surgery and radiation.
Purpose To assess the efficacy of deep convolutional neural networks (DCNNs ) in differentiating acute aortic dissections from non-dissected aortas on thoracic CT.
We present a successful case of catheter-directed infusion into the SMA for a patient with NOMI complicated with traumatic type B AD involving the SMA. Vasodilator infusion via arterial catheter has been reported as an effective treatment for NOMI and many reports suggested efficacy of this strategies [4-7]. In 1977, Boley et al. decreased mortality rate from about 70-80% to 40% performing catheter intra-arterial infusion of papaverine [8]. Other recent study revealed vasodilator administration from SMA achieved successful treatment in 64% patients of NOMI after open heart surgery with nonsurgical treatment [7]. The strategy and management of NOMI with type B AD involving the SMA have not yet been established, and research is limited [1]. Thus, there are two overwhelming difficulties: risk from the catheterization of the dissected aorta and the accurate and prompt evaluation of NOMI.. First, the catheterization of and arterial infusion for the dissected aorta are essential, and more safety ...
Type B aortic dissection (AoD) is a disease connected to high blood load on the aortic wall and to a reduced aortic wall resistance. Nowadays, prognosis on type B AoD results to be particularly difficult with an high incidence of patients treated with medical therapy which manifest complication connected with dissection and which should have been treated with surgical repair immediately. This work aims to study those haemodynamical and morphological proprieties of dissected aorta, which can influence the progression or stability of type B AoD. Computational fluid-dynamic analyses were performed on twenty-five patients with type B AoD, whose nine presented an aneurysm evolution and sixteen presented no further complication connected with dissection. Blood flow features showed that the true lumen flow was laminar and uniform while false lumen flow was less homogeneous with a consequent recirculating path. We found that entry point zone proximal to the aortic arch showed both high blood velocity ...
There is a crescentic hyperdensity within the ascending thoracic aorta, likely representing a dissection flap containing previously administered IV contrast. The dissection flap measures approximately 3 mm along the posterior surface of the ascending aorta. There are calcifications along the aortic arch and descending aorta, probably representing atherosclerosis. ...
RADIOLOGY: AORTA: Case# 17: EXAM 1:AORTIC DISSECTION, TYPE B EXAM2:. A 66 year old female with chest pain. The ascending aorta and aortic arch appear normal. There is aortic dissection in the descending thoracic aorta beginning immediately distal to the arch and extending into the proximal abdominal aorta. The true lumen is compressed and false lumen is significantly thrombosed. CT has to a large degree replaced arteriography in diagnosing aortic dissection and determining its type and location. The diagnosis is made by the demonstration of an intimal flap, displaced inward from the edge of the aorta and lying between the true and false channels. In Dailys classification, types A and B are described with type A being more common. Type A involves the ascending aorta and is usually treated surgically because of the potential for retrograde dissection. Type B involves the area distal to the left subclavian artery and is treated medically. CT is used for screening those with suspected aortic dissection
As it is mentioned in the same publication, type I dissections usually have excellent prognosis. In our case, there was initial spontaneous healing of the LMCA dissection, which later progressed into Type III dissection. In 2000, Dunning et al (9) suggested classification of iatrogenic aortic dissection, based on its spread: type 1 was determined when dissection was limited to a sinus of Valsalva, type 2 when it went to ascending aorta but less than 4 cm in length and type 3 exceeding 4 cm. Thus, the patient developed type 3 dissection. However, there were signs of thrombus formation in the false lumen on MDCT angiography and clinically acute myocardial infarction was the culprit for the patients deterioration. Therefore, as well as because of the emergency of terminal condition "only" CABG was performed.. Conclusions Iatrogenic coronary artery dissection can lead to lethal effect despite all medical efforts. In order to prevent such a serious complication during percutaneous coronary ...
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Level C recommendations. In adult patients with suspected nontraumatic thoracic aortic dissection, do not rely on D-dimer alone to exclude the diagnosis of aortic dissection.. Ongoing challenge regarding the role of D-Dimer in TAD, and some assurance to back up our discussion to not rely on D-Dimer in case of suspicious for TAD. Link To Clinical Policy. ...
Is there any kind of organisation in the UK dedicated to raising awareness of Acute Aortic Dissection or to raising funds for research into the condition? Th…
An aortic dissection starts with a tear in the inner layer of the aortic wall of the thoracic aorta. The aortic wall is made up of 3 layers of tissue. When a tear occurs in the innermost layer of the aortic wall, blood is then channeled into the wall of the aorta separating the layers of tissues. This generates a weakening in the aortic wall with a potential for rupture. Aortic dissection can be a life-threatening emergency. The most commonly reported symptom of an acute aortic dissection is severe, constant chest or upper back pain, sometimes described as "ripping" or "tearing." The pain may move from one place to another.. When a diagnosis of aortic dissection is confirmed, immediate surgery or stenting is usually done.. ...
An aortic dissection starts with a tear in the inner layer of the aortic wall of the thoracic aorta. The aortic wall is made up of 3 layers of tissue. When a tear occurs in the innermost layer of the aortic wall, blood is then channeled into the wall of the aorta separating the layers of tissues. This generates a weakening in the aortic wall with a potential for rupture. Aortic dissection can be a life-threatening emergency. The most commonly reported symptom of an acute aortic dissection is severe, constant chest or upper back pain, sometimes described as "ripping" or "tearing." The pain may move from one place to another.. When a diagnosis of aortic dissection is confirmed, immediate surgery or stenting is usually done. ...
Dan Rong, Yangyang Ge, Yan Xue, Feng Liu, Kai Lu, Peng Liu, Lei Zhang, Xiaohu Ge, Jianhang Miu, Linkun Zhong, Weidong Fan, Hongpeng Zhang, Xin Jia, Xiaohui Ma, Jiang Xiong, Xiaoping Liu, Wei Guo ...
Medtronic plc (MDT) recently unveiled favorable three-year clinical outcome of its Valiant Captivia Thoracic Stent Graft System in patients with acute complicated Type B aortic dissection.
Lombardi, global principal investigator of the study, presented study results through 24 months, reflective of data received as of March 2013. The overall 30-day mortality rate was 4.7% (4/86), and Kaplan-Meier estimates of patient survival were 88% at 12 months and 85% at 24 months. During follow-up through two years, five patients experienced aortic rupture and no patient required conversion to open repair. There were seven cases of stroke (six cases within 30 days) and one case of paraplegia (within 30 days). Renal failure occurred in nine patients (none required permanent dialysis) and retrograde dissection occurred in seven patients (two patients died; four underwent re-interventions). Aortic remodeling, indicated by an increase in the true lumen size and a decrease in the false lumen size, was observed in both the descending thoracic aorta and the distal abdominal aorta.. ...
We believe that this patient had symptoms associated with her vasculitis during the months before admission. The aortic dissection may have explained her abdominal pain and diarrhoea (transient intestinal ischaemia) and was presumably responsible for compromised perfusion of the right kidney, which caused high renin, new onset hypertension. The left kidney was atrophic, suggesting longstanding renovascular disease, which had not caused hypertension before she developed aortic disease. Thus, an important lesson is that acute hypertension, in particular with signs of activation of the renin-angiotensin-aldosterone system (hypokalaemia, mild hyponatraemia, hyperreninaemia, strong blood pressure response to ACE inhibition or angiotensin receptor blockade), should trigger suspicion of aortic disease, especially in elderly people. Aortic dissection can present with few symptoms and be easily overlooked. Hypertension occurs in about half of patients with aortic dissection and may be caused by ...
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Abstract: Background: There is an increased risk of stroke during pregnancy and the puerperium. This risk is greatest in the post-partum period. Embolic sources secondary to cardiac abnormalities and cerebral arterial dissection are recognized as potential etiologies. Case: A 32-year-old woman presented with left-sided weakness eight days post-partum. Imaging studies identified infarction in the territory of the right middle cerebral artery. Cardiac investigations revealed acute myocardial infarction secondary to dissection of the left main coronary artery. The patient underwent coronary artery bypass grafting with significant recovery of cardiac function. At two years post-presentation, her neurological deficits have resolved. Discussion: Myocardial infarction secondary to coronary artery dissection has been long-recognized. Cerebral arterial dissection in association with pregnancy is also well-documented. This is a rare case of a patient presenting with stroke secondary to acute myocardial ...