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PubMed1999

Right axillary arterial perfusion for a ruptured type B aortic dissection: report of a case.

The results of surgical treatment for a ruptured type B aortic dissection remain far from satisfactory. It is believed that additional perfusion from the right axillary artery might be more beneficial than perfusion from only the femoral artery during surgery for a ruptured thoracic aneurysm. The right axillary perfusion is more likely to perfuse the vital organs proximal to the ruptured area, and thus avoid retrograde emboli. In addition, if the open proximal method is performed, then the right axillary perfusion is able to facilitate the evacuation of air from the aortic lumen. We present herein the case of a patient in whom a ruptured type B acute aortic dissection was successfully treated by applying right axillary perfusion through a left thoracotomy.

Aged↗
PubMed1997

Pregnancy with aortic dissection in Ehler-Danlos syndrome. Staged replacement of the total aorta (10-year follow-up).

Pregnancy complicated by aortic dissection in patients with hereditary disorder of connective tissue presents interesting considerations including management of caesarean section with the unexpected need for cardiac surgery in emergency. Generalizations can be made on management principles with long-term follow-up requiring an aggressive individualized approach by a multidisciplinary team. A 33-year-old parturient presenting an aortic dissection at 37 weeks gestation required prompt diagnosis of Ehlers-Danlos syndrome in combination with correct surgical therapy resulted in the survival of both the mother and infant. During the 10-year follow-up, multiple complex dissection required transverse aortic arch and thoracoabdominal aortic replacement.

Adult↗
PubMed1991

[Clinical application of total body retrograde perfusion to aortic dissection operation].

Open distal anastomosis technique proposed by Cooley facilitates operative management of aortic dissection. Usually this procedure is performed under circulatory arrest, therefore, prolonged management is hazardous to cerebral and visceral organ systems. We have utilized profound hypothermia with total body retrograde perfusion: 1) myocardial protection through coronary sinus, 2) cerebral perfusion through superior vena cava with pretreatment of cerebral protective drugs, 3) abdominal visceral perfusion through inferior vena cava). We have obtained good results with this method in consecutive four patients with aortic dissection.

Adolescent↗
PubMed2002

Acute atypical type-A thoracic aortic dissection with intramural hematoma: the importance of patient symptoms and the transthoracic echocardiographic examination.

This report demonstrates how transthoracic echocardiography, in conjunction with the sonographer's attention to patient symptomatology, heightened the clinical suspicion of an atypical aortic dissection, leading to further investigation and confirmation. Although initially undiagnosed by computed tomography, a structure suggestive of aortic dissection was subsequently found by transthoracic echocardiography. Transesophageal echocardiography and a second computed tomography examination validated the transthoracic findings. An atypical type A aortic dissection with intramural hematoma was confirmed at operation.

Acute Disease↗
PubMed1992

Type A aortic dissection: evaluation with ultrafast CT.

The authors examined 17 patients with type A aortic dissection with ultrafast computed tomography (CT). Forty sections with 1-cm intervals, from the aortic arch to the aortic bifurcation, were scanned serially without breath holding within only 74 seconds. Except for two thrombosed dissections, all intimal flaps in the ascending aorta were demonstrated, and 14 (93%) of the 15 surgically proved intimal tears were depicted. An intimal tear in the aortic arch was missed. Since conventional scanning tends not to depict type A aortic dissection, millisecond-order ultrafast CT scanning has the potential to become the modality of choice for imaging of aortic dissection.

Adult↗
PubMed2006

Endovascular stent-grafts treatment in acute aortic dissection (type B): clinical outcomes during early, late, or chronic phases.

OBJECTIVE: This is a prospective study to evaluate the clinical outcomes of endovascular repair in patients with different phases of type B aortic dissection. BACKGROUND: Endovascular repairing with stent-grafts is an innovative technique for type B acute aortic dissection. There is no previous study regarding outcomes in different time phases. METHODS: Sixty-two patients underwent endovascular stent-grafts. There were 23 in the early phase (<24 hr), 20 in the late phase (>or=24 hr to 2 weeks), and 19 in the chronic phase (>2 weeks). RESULTS: The early phase group had the lowest ratio of stent-grafts to patient and the shortest stent-graft length. The chronic phase group had the largest diameter of false lumen. The technical success rate was 100%; no patient died within hospital. Three patients died within 30 days, with the same death rate in every group. Compared with acute patients, the chronic group had a higher volume of contrast, a higher creatinine post-procedure, and a higher incidence of contrast-induced nephropathy. Multiple regression analysis demonstrated that creatinine and endoleak were independent factors in predicting late death (95% CI, 3.4-26%, P < 0.01). The overall cardiovascular event-free survival was 88.9% +/- 2.1% at 30 days, 87.2% +/- 4.1% at 1 year, and 81.4% +/- 6.3% at 2 years. CT angiography identified the complete or partial thrombosis of the false lumen to be 95.7%. CONCLUSIONS: Endovascular repairing with stent-graft is safe, feasible, and able to treat type B aortic dissection in all phases. However, chronic renal dysfunction was an independent factor which contributed to a lower survival rate of chronic phase patients.

Acute Disease↗
PubMed2003

Acute aortic dissection after off-pump coronary artery surgery.

Iatrogenic aortic dissection has been described, albeit infrequently, after coronary artery surgery performed under cardiopulmonary bypass. Since the advent of beating heart coronary surgery, several authors have described an apparent increase of this complication related to the application of a lateral clamp on the ascending aorta to perform the proximal anastomosis. We describe the case of a 70 years old patient who presented aortic dissection, with immediate paraplegia, 7 days after off-pump coronary surgery.

Acute Disease↗
PubMed2000

[A case of chronic localized thoracoabdominal aortic dissecting aneurysm].

A rare case of chronic localized thoracoabdominal aortic dissecting aneurysm was surgically treated. The patient was a 76-year-old woman. She was reffered to our hospital because of the abnormality of the chest roentogenogram. Chest CT and aortography revealed localized thoracoabdominal dissecting aneurysm 70 mm in diameter. Patch closure of intimal tear was carried out under partial cardiopulmonary femoro-femoral bypass. The patient discharged on the 23rd post operative day without any complications.

Aortic Dissection↗
PubMed2003

Stent-graft detachment from aortic wall after stent-graft repair of acute aortic dissection.

Preliminary studies have demonstrated that stent-graft repair is an attractive method for treatment of aortic dissection. However, few reports have described long-term results. A 72-year-old woman with acute type B aortic dissection underwent stent-graft repair. The entry was closed, and the false lumen disappeared completely. The postoperative course was uneventful for 4 years 5 months, when detachment of the stent graft from the aortic wall was noted. Because the device appears to be stable, follow-up is on an outpatient basis.

Aged↗
PubMed1996

[Arterial hypertension complicated by aortic dissection. Clinical analysis, results of conservative treatment].

Detailed analysis of 21 patients suffering from arterial hypertension complicated by aortic dissection, who were treated non-surgically was performed. Signs and symptoms of aortic dissection appeared the most frequently in the age between 50 and 69. In 14 (66.7%) cases proximal (type A) and in 7 (33.3%) distal (type B) dissection were diagnosed. During acute phase 15 patients complained of pain and 6 did not. Smoking and family history of arterial hypertension were the commonest risk factors in this group. Proximal dissection was more frequently connected with painful course of the dissection whereas distal with painless. Detailed analysis of clinical data and non-invasive treatment during acute phase (first 14 days since onset of pain) was performed. During ambulatory observation which lasted 3-75 month (mean 34.3 month) 5 (25%) patients died, 15 (75%) are still alive.

Adult↗
PubMed1990

Duplex ultrasound of the abdominal aorta--a neglected tool in aortic dissection.

The use of duplex ultrasound for the diagnosis and assessment of abdominal aortic dissection and visceral arterial involvement is discussed. Ultrasound is simple and non-invasive and may be superior to aortography in diagnosis; it should be performed after ultrasound assessment of the aortic root. It also provides an effective means of follow-up evaluation if conservative treatment is employed. Three cases are discussed in whom there was no operative intervention. In one case, aortography failed to make a positive diagnosis of aortic dissection. The diagnosis was made by ultrasound in all three cases, one of whom was found subsequently to have Marfan's syndrome.

Adult↗
PubMed2000

Radiofrequency induction heating for the treatment of aortic dissection in an animal model.

BACKGROUND: In this study, radiofrequency (RF) induction heating therapy using a self-expanding Gianturco metallic stent (G-EMS) to treat acute aortic dissection was evaluated. METHODS: We evaluated convergent RF induction heating of G-EMS in pigs. In group A (n=3), an aortic dissection was created to determine the natural course of this lesion. In group B (n=4), 0.40 mm stainless steel bare G-EMSs (2.5 cm, 10 bends) were placed in the aorta 5 to 7 days after dissection, and RF induction heating was performed for 30 (n=2) or 45 (n=2) minutes. In group C (n=6), G-EMSs with 0.10 mm ferro-chrome wire mounted on alternating stent legs were placed in the aorta 1 to 7 days after dissection, and RF induction heating was performed for 10 minutes. RESULTS: In group A, 2 pigs died from rupture of the false lumen. In group B, fusion of the dissection flap was confirmed histologically. However, all of the pigs died. In group C, all of the pigs tolerated the procedure, and fusion of the dissection flap was confirmed in all of the pigs. CONCLUSIONS: This experimental animal study suggested that RF induction heating combined with G-EMS, if properly applied, has a potential to treat acute aortic dissection.

Aortic Dissection↗
PubMed1986

Radiology of aortic dissection: pitfalls in diagnosis.

The diagnosis of aortic dissection can be made with certainty when computed tomography or aortography reveals two lumina and a intimal flap between them. If the false lumen is thrombosed, the differential diagnosis between dissection and aneurysm with intraluminal thrombus is difficult. High resolution computed tomography with dynamic scanning seems more effective in differentiating these two entities than aortography. Two illustrative cases are presented.

Aged↗
PubMed1992

Percutaneous recanalization of a renal artery in aortic dissection.

Chronic renal failure acutely worsened in a patient with a type B aortic dissection. Aortography revealed an occlusion of the left renal artery without renal intimal tear. Percutaneous recanalization, performed with a self-expandable stent, resulted in improvement in the renal function. This technique offers a new therapeutic choice in patients with visceral complications of aortic dissection.

Aortic Dissection↗
PubMed2001

Treatment of chronic aortic dissection by transluminal endovascular stent-graft placement: preliminary results.

PURPOSE: To investigate efficacy of stent-graft repair for the treatment of patients with chronic aortic dissection. MATERIALS AND METHODS: Fifteen patients with chronic aortic dissection were treated with endovascular stent-grafts. Entry tears were located in the descending thoracic aorta in all patients. The mean maximum diameter of the descending thoracic aorta was 47 mm +/- 8. The mean diameter of the true lumen at the same level was 20 mm +/- 5. The mean interval between diagnosis and stent-graft procedure was 32 months +/- 91. Stent-grafts were fabricated from expanded polytetrafluoroethylene and Z-stents. RESULTS: Stent-grafts were placed successfully in all patients. Two stent-grafts were required in one patient. Entry closure and thrombosis of the false lumen of the descending thoracic aorta were also achieved in all patients. No procedure-related complications were observed except for postimplantation syndrome, including fever and leukocytosis. The diameter of the true lumen was significantly increased (mean, 31 mm +/- 6) at the level of the descending thoracic aorta (P <.01) and the diameter of the aorta was significantly decreased (mean, 44 mm +/- 8) at the same level (P <.01). There were no deaths and no instances of aortic rupture during the subsequent average follow-up period of 24 months. Secondary stent-graft procedures were required to treat the abdominal component of dissection during follow-up in one patient. CONCLUSIONS: Stent-graft repair of chronic aortic dissection is a safe and effective method and may be an alternative to surgical graft replacement in selected patients. However, further evaluation is mandatory before this method is widely employed.

Adult↗
PubMed1993

[Acute aortic dissection after coronary revascularization--a case report].

A 59-year-old man with coronary artery disease and arteriosclerosis obliterans of left lower extremity underwent anastomosis of left internal thoracic artery to left anterior descending artery with cardiopulmonary bypass of aortic perfusion and left femoro-popliteal bypass with saphenous vein graft. On the first postoperative day, urinary output decreased and then stopped. The transesophageal echocardiography and angiography revealed the Stanford A type acute aortic dissection. Immediately the resection of the ascending aorta including the intimal tear, which was found on the site of the previous aortic perfusion, and the reconstruction of the ascending aorta with the prosthetic graft was performed. After the reperfusion of left femoral artery, which was used as the route of the arterial perfusion during cardiopulmonary bypass, serum potassium level increased gradually and at last the heart was arrested. Hemodialysis with draining from inferior vena cava produced the stability of hemodynamics, but on the next day he died of low cardiac output syndrome. We presented the case with the acute aortic dissection after open heart surgery, which was one of the rare complications in aortic perfusion of cardiopulmonary bypass and emphasized the possibility of occurrence of myonephropathic-metabolic syndrome after the repair of acute aortic dissection with limb ischemia.

Acute Disease↗
PubMed2004

Aorto-right atrial fistula caused by type A aortic dissection.

We present a rare surgical case of aorto-right atrial fistula caused by type A aortic dissection in an 85-year-old man. Complaints included progressive general fatigue and anorexia caused by right side heart failure. However, there were no symptoms attributable to onset of the aortic dissection. A diagnosis of aorto-right atrial fistula was made from intraoperative transesophageal echocardiography. Total aortic arch replacement concomitant with direct closure of the fistula was performed successfully.

Aged↗
PubMed2005

Treatment of type B aortic dissection: endoluminal repair or conventional medical therapy?

OBJECTIVE: To evaluate the mid-term results of endovascular stent-grafting for type B aortic dissection, in comparison with those of standard medical therapy in uncomplicated cases. METHODS: Between January 1999 and 2004, among 56 patients (mean age 59.5+/-11.5 years) with type B aortic dissection, hypotensive medical therapy was the only treatment in 28 uncomplicated cases, (group A), while stent-graft implantation was performed in 28 patients with uncontrolled hypertension, persistent pain or evidence of dissection progression or complication (group B). In 14 cases (50%) the procedure was performed in an acute setting. Stent-grafting procedures were monitored with intraoperative trans-esophageal echocardiography and cine-angiography. CT scan and trans-esophageal echocardiography were performed before hospital discharge, at 6 and 12 months and then yearly. RESULTS: Follow-up (range 1-61 months, average 18.1+/-16.9 months) was 100% complete. In-hospital mortality was 10.7% (three patients, all belonging to Group B; P=0.24). No spinal cord injuries were observed. Early endoleak occurred in one patient (3.5%). Mid-term mortality was lower in Group B, although the difference was not significant (10.7 versus 14.3% in Group A, P=0.71). Follow-up CT scans evidenced complete thrombosis of the false lumen in 75% cases in Group B, 10.7% in Group A (P=0.0001), and an aneurismal dilatation of the descending aorta in 3.5% cases in Group B, 28.5% in Group A (P=0.02). CONCLUSIONS: Although with still considerable early mortality, endovascular stent-graft implantation is an effective option for the treatment of complicated type B aortic dissection. Endovascular treatment achieved a better mid-term fate of the descending thoracic aorta than medical therapy alone, even in patients with worse preoperative conditions.

Acute Disease↗