The Impact of Pure Symptom-driven in All Indications for Tevar Procedure to Treat Complicated Acute Type B Aortic Dissection

Background: The impact of thoracic endovascular aortic repair (TEVAR) on pulsatile aortic strain remains undetermined in patients with Type B aortic dissection (TBAD). Therefore, we quantified pulsatile aortic strain in TBAD patients and control subjects. Methods: We retrospectively analyzed two TBAD patients from our database with cardiac-gated computed tomography angiography imaging available before and after TEVAR and two control subjects (67- and 76-year-old males). Patient 1 (54-year-old female) presented with acute TBAD, and Patient 2 (55-year-old male) had Marfan syndrome and ruptured acute TBAD. Custom-developed software was used to compute aortic length, diameter, and area during the cardiac cycle. Pulsatile strain was calculated as systolic increments of length and circumference divided by corresponding diastolic values. Results: Before TEVAR, pulsatile longitudinal strain of the thoracic aorta was lower in TBAD patients (1.4–1.7%) than in control subjects (2.1–4.5%). After TEVAR, pulsatile longitudinal strain increased proximal to the stent-graft by 65% in the arch of Patient 1 and by 70% in the ascending aorta of Patient 2. Pulsatile circumferential strain was elevated in false lumen patency (4.4–6.2%) compared with thrombosed false lumen (1.4–2.1%) or control subjects (0.9–3.3%). Following TEVAR, circumferential measurements within stented segments were deemed unreliable due to artifacts. Conclusions: TEVAR led to a considerable increase of pulsatile longitudinal strain proximal to the stent-grafts, and TBAD was associated with longitudinally stiffer aortas, which may be part of the pathophysiology of TEVAR-related complications such as retrograde dissection and aneurysmal dilatation. These preliminary data call for larger prospective studies.

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A Primary Computational Fluid Dynamics Study of Pre- and Post-TEVAR With Intentional Left Subclavian Artery Coverage in a Type B Aortic Dissection

Journal of Biomechanical Engineering ◽

10.1115/1.4043881 ◽

2019 ◽

Vol 141 (11) ◽

Cited By ~ 3

Author(s):

Yonghui Qiao ◽

Jianren Fan ◽

Ying Ding ◽

Ting Zhu ◽

Kun Luo

Keyword(s):

Blood Flow ◽

Aortic Dissection ◽

Subclavian Artery ◽

Left Subclavian Artery ◽

Model Parameters ◽

Acute Type ◽

Type B ◽

Type B Aortic Dissection ◽

True Lumen ◽

The Impact

The impact of left subclavian artery (LSA) coverage during thoracic endovascular aortic repair (TEVAR) on the circulatory system is not fully understood. Here, we coupled a single-phase non-Newtonian model with fluid–structure interaction (FSI) technique to simulate blood flow in an acute type B aortic dissection. Three-element Windkessel model was implemented to reproduce physiological pressure waves, where a new workflow was designed to determine model parameters with the absence of measured data. Simulations were carried out in three geometric models to demonstrate the consequence of TEVAR with the LSA coverage; case A: pre-TEVAR aorta; case B: post-TEVAR aorta with the disappearance of LSA; case C: post-TEVAR aorta with virtually adding LSA. Results show that the blood flow through the compressed true lumen is only 8.43%, which may lead to ischemia in related organs. After TEVAR, the wall pressure on the stented segment increases and blood flow in the supra-aortic branches and true lumen is improved. Meantime, the average deformation of the aorta is obviously reduced due to the implantation of the stent graft. After virtually adding LSA, significant changes in the distribution of blood flow and two indices based on wall shear stress are observed. Moreover, the movement of residual false lumen becomes stable, which could contribute to patient recovery. Overall, this study quantitatively evaluates the efficacy of TEVAR for acute type B aortic dissection and demonstrates that the coverage of LSA has a considerable impact on the important hemodynamic parameters.

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Outcome of Medical and Surgical Treatment in Patients With Acute Type B Aortic Dissection

Yearbook of Vascular Surgery ◽

10.1016/s0749-4041(08)70471-8 ◽

2007 ◽

Vol 2007 ◽

pp. 169-170

Author(s):

G.L. Moneta

Keyword(s):

Surgical Treatment ◽

Aortic Dissection ◽

Acute Type ◽

Type B ◽

Type B Aortic Dissection

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A new mechanism why an acute type B aortic dissection is primary complicated, becomes complicated or remains uncomplicated

The Thoracic and Cardiovascular Surgeon ◽

10.1055/s-0030-1269218 ◽

2011 ◽

Vol 59 (S 01) ◽

Author(s):

M Czerny ◽

C Loewe ◽

G Sodeck ◽

J Ta ◽

M Schoder ◽

...

Keyword(s):

Aortic Dissection ◽

Acute Type ◽

Type B ◽

Type B Aortic Dissection

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Surgical treatment of acute type B aortic dissection associated with use of cocaine

Orvosi Hetilap ◽

10.1556/oh.2009.28541 ◽

2009 ◽

Vol 150 (3) ◽

pp. 129-131 ◽

Cited By ~ 1

Author(s):

Zoltán Szeberin ◽

Gábor Firneisz ◽

Gábor Bíró ◽

Gábor Viktor Szabó ◽

Péter Sótonyi ◽

...

Keyword(s):

Surgical Treatment ◽

Aortic Dissection ◽

Acute Type ◽

Type B ◽

Type B Aortic Dissection

A kokainfogyasztás gyakorisága Magyarországon is növekszik. E drog használata fokozott kockázatot jelent szív- és érrendszeri betegségek kialakulása, például aortadissectio szempontjából. Klinikánkon zajlik hazánkban a B típusú aortadissectiós betegek döntő többségének ellátása. Célkitűzés: Egy rendszeresen kokaint használó, akut B típusú aortadissectiót elszenvedett beteg műtéti kezelését mutatjuk be esetismertetésünkben, amely tudomásunk szerint az első hasonló eset hazánkban. Módszer: Esetleírás. Eredmények: Egy 35 éves férfi erős, mellkasi-háti-deréktáji fájdalmak miatt először a gerincsebészeti osztályhoz fordult, majd kiugróan magas vérnyomásértékek miatt belgyógyászati osztályra helyezték át. A B típusú aortadissectio diagnózisát CT-angiographia igazolta, a beteg érsebészeti centrumba került, ahol sikeres műtétet, thoracoabdominalis aortarefenesztrációt végeztünk. A beteg 3 hónappal a műtét után jól van, antihipertenzív szerek szedése mellett mindennapi feladatait ellátja, szövődményt nem észleltünk, a kokainról leszokott. Következtetések: Az akut B típusú dissectio sebészi ellátása megmentheti a beteg életét. A hosszú távú eredményes kezelésben a hipertónia kontrollja mellett a kokainról történő leszokás alapvető jelentőségű. Hasonló esetek előfordulására a kokainfogyasztás növekedése esetén hazánkban is számíthatunk.

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