scholarly journals Partially Resorbable Mesh Inclusion between Dissected Layers during Surgical Repair of Aortic Dissection

Aorta ◽  
2021 ◽  
Vol 09 (06) ◽  
pp. 235-237
Author(s):  
Corrado Cavozza ◽  
Tommaso Regesta ◽  
Antonio Campanella ◽  
Glauco Camporini ◽  
Andrea Audo
Keyword(s):  
Aortic Dissection ◽  
Surgical Management ◽  
Aortic Wall ◽  
Surgical Repair ◽  
Dacron Graft ◽  
End To End

AbstractSurgical management of aortic dissection is technically challenging for different reasons. Reapproximation of dissected layers because of fragility of the dissected aortic wall layers is of major concern. Many techniques have been described to restore the integrity of aortic wall. Inclusion of a partially resorbable mesh fixed with glue, between the dissected layers, may be a simple and effective method for providing a secure and viable end-to-end anastomosis between aortic stump and a Dacron graft.

Surgical management of extracranial carotid artery aneurysms

VASA ◽  
2016 ◽  
Vol 45 (3) ◽  
pp. 223-228 ◽  
Author(s):  
Jan Paweł Skóra ◽  
Jacek Kurcz ◽  
Krzysztof Korta ◽  
Przemysław Szyber ◽  
Tadeusz Andrzej Dorobisz ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Surgical Management ◽  
Minor Stroke ◽  
Stroke Rate ◽  
Extracranial Carotid Artery ◽  
Long Term Follow Up ◽  
End To End ◽  
Dacron Patch ◽  
Major Stroke

Abstract. Background: We present the methods and results of the surgical management of extracranial carotid artery aneurysms (ECCA). Postoperative complications including early and late neurological events were analysed. Correlation between reconstruction techniques and morphology of ECCA was assessed in this retrospective study. Patients and methods: In total, 32 reconstructions of ECCA were performed in 31 symptomatic patients with a mean age of 59.2 (range 33 - 84) years. The causes of ECCA were divided among atherosclerosis (n = 25; 78.1 %), previous carotid endarterectomy with Dacron patch (n = 4; 12.5 %), iatrogenic injury (n = 2; 6.3 %) and infection (n = 1; 3.1 %). In 23 cases, intervention consisted of carotid bypass. Aneurysmectomy with end-to-end suture was performed in 4 cases. Aneurysmal resection with patching was done in 2 cases and aneurysmorrhaphy without patching in another 2 cases. In 1 case, ligature of the internal carotid artery (ICA) was required. Results: Technical success defined as the preservation of ICA patency was achieved in 31 cases (96.9 %). There was one perioperative death due to major stroke (3.1 %). Two cases of minor stroke occurred in the 30-day observation period (6.3 %). Three patients had a transient hypoglossal nerve palsy that subsided spontaneously (9.4 %). At a mean long-term follow-up of 68 months, there were no major or minor ipsilateral strokes or surgery-related deaths reported. In all 30 surviving patients (96.9 %), long-term clinical outcomes were free from ipsilateral neurological symptoms. Conclusions: Open surgery is a relatively safe method in the therapy of ECCA. Surgical repair of ECCAs can be associated with an acceptable major stroke rate and moderate minor stroke rate. Complication-free long-term outcomes can be achieved in as many as 96.9 % of patients. Aneurysmectomy with end-to-end anastomosis or bypass surgery can be implemented during open repair of ECCA.

scholarly journals Surgery out of office hours for type A aortic dissection: does night-time and weekend surgery worsen outcome?

2020 ◽  
Vol 31 (6) ◽  
pp. 806-812
Author(s):  
Simone Gasser ◽  
Lukas Stastny ◽  
Markus Kofler ◽  
Vitalijs Zujs ◽  
Christoph Krapf ◽  
...  
Keyword(s):  
Aortic Dissection ◽  
Emergency Surgery ◽  
Odds Ratio ◽  
Surgical Repair ◽  
Type A ◽  
Skin Incision ◽  
Night Time ◽  
Femoral Access ◽  
Type A Aortic Dissection ◽  
Malperfusion Syndrome

Abstract OBJECTIVES Immediate surgical repair for type A aortic dissection is gold standard and at most centres is performed by the surgeon on call during night-time and weekends. The objective was to evaluate whether emergency surgery during night-time or weekends has an influence on 30-day mortality. METHODS In 319 patients undergoing surgery for type A aortic dissection, skin incision was documented. Patients were divided into 2 groups according to the time point of skin incision (05:00 a.m. to 07:00 p.m. = daytime group; 07:01 p.m. to 04:59 a.m. = night-time group). We also noted whether their surgeries were started on weekdays (Monday 00:00 to Friday 23:59) or weekends (Saturday 00:00 to Sunday 23:59). RESULTS The median age was 61 years (interquartile range 49–70) and 69.6% (n = 222) were male. Almost 50% (n = 149) of patients presented in a critical preoperative state. Forty-one percent of patients (n = 131) underwent night-time surgery. There were no differences in baseline data, time from onset of symptoms to surgery or surgical treatment between groups, except from preferred femoral access for arterial cannulation during night-time. Advanced age [odds ratio 1.042, 95% confidence interval (CI) 1.014–1.070], preoperative malperfusion syndrome (odds ratio 2.542, 95% CI 1.279–5.051) and preoperative tamponade (odds ratio 2.562, 95% CI 1.215–5.404) emerged as risk factors for 30-day mortality. Night-time or weekend surgery did not have any impact on 30-day mortality when covariates were considered. CONCLUSIONS Based on the natural course of the disease and our results, surgery for type A aortic dissection should be performed as an emergency surgery regardless of time and day.

scholarly journals Enlargement of aortic arch vessels after surgical repair of type A aortic dissection

2017 ◽  
Vol 65 (3) ◽  
pp. 669-675 ◽  
Author(s):  
Takashi Yamauchi ◽  
Suguru Kubota ◽  
Toshihiro Ohata ◽  
Kosei Hasegawa ◽  
Hideki Ueda
Keyword(s):  
Aortic Dissection ◽  
Aortic Arch ◽  
Surgical Repair ◽  
Type A ◽  
Type A Aortic Dissection

scholarly journals Acute Aortic Dissection in Pregnancy in a Woman with Undiagnosed Marfan Syndrome

2012 ◽  
Vol 2012 ◽  
pp. 1-3 ◽  
Author(s):  
Mandana Master ◽  
Gavin Day
Keyword(s):  
Aortic Dissection ◽  
Marfan Syndrome ◽  
Acute Aortic Dissection ◽  
Congenital Abnormalities ◽  
Surgical Repair ◽  
Phenotypic Expression ◽  
Sudden Onset ◽  
Lower Segment Caesarean Section ◽  
Type B Dissection ◽  
Type A Dissection

We report a case of acute aortic dissection in a lady of 28 weeks of gestation with undiagnosed Marfan syndrome. The patient had been seen in our antenatal clinics. Her history documented in her pregnancy record was negative for genetic/congenital abnormalities. There was no family history documented. Subsequently, at 28 weeks of gestation, the patient presented with sudden onset chest, jaw, and back pain. Further history revealed that her father had died at the age of 27 of an aortic dissection. Echocardiography showed aortic root dissection with occlusion of aortic branches. She subsequently underwent an emergency lower segment caesarean section followed by surgical repair of type A dissection. A simultaneous type B dissection was managed conservatively. On later examination, our patient fulfilled the diagnostic criteria for phenotypic expression of Marfan syndrome. Genetic testing also confirmed that she has a mutation of the fibrillin (FBN 1) gene associated with the disease.

Tracheoinnominate fistula: surgical management of an iatrogenic disaster

2006 ◽  
Vol 120 (8) ◽  
pp. 676-680 ◽  
Author(s):  
R W Ridley ◽  
J B Zwischenberger
Keyword(s):  
Operating Room ◽  
Surgical Management ◽  
Surgical Repair ◽  
Surgical Intervention ◽  
Pectoralis Major Muscle ◽  
Muscle Flap ◽  
Rare Condition ◽  
Innominate Artery ◽  
Significant Potential ◽  
High Index Of Suspicion

Tracheoinnominate fistula (TIF) is a rare condition with significant potential for mortality if surgical intervention is not immediate. We present two cases of successfully managed TIF. Both cases involve ligation and resection of the innominate artery at the TIF followed by a pectoralis major muscle flap. In both cases, success was largely due to a high index of suspicion and immediate control of the bleeding with transport to the operating room for surgical repair. The history, aetiology, and pathogenesis of TIF are reviewed, yielding an algorithm for recommended management of TIF.

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