scholarly journals Role of Extra-anatomic Ascending to Descending Bypass in Complex Thoracic Aortic Pathology

Aorta ◽  
2021 ◽  
Vol 09 (06) ◽  
pp. 228-230
Author(s):  
Mariano Camporrotondo ◽  
Sebastian Pagni
Keyword(s):  
Thoracic Aorta ◽  
Cardiac Disease ◽  
Aortic Disease ◽  
Descending Thoracic Aorta ◽  
Graft Replacement ◽  
Active Infection ◽  
Aortic Bypass ◽  
Aortic Pathology

AbstractComplex pathology of the distal arch and proximal descending thoracic aorta is usually approached by stent endografting or in situ graft replacement. Oftentimes, these options are not feasible due to unfavorable anatomy, multiple previous procedures, active infection, or presence of concomitant cardiac disease. Thoracic aortic extra-anatomic bypass, as part of an open surgical strategy, is a useful and often the only curative option left for the treatment in these patients. Herein, we describe two cases that illustrate the utility of extra-anatomic thoracic aortic bypass for complex aortic disease.

The Results of In Situ Prosthetic Graft Replacement for Infected Aortic Disease

2018 ◽  
Vol 42 (9) ◽  
pp. 3035-3041 ◽  
Author(s):  
Youngjin Han ◽  
Tae-Won Kwon ◽  
Sang Jun Park ◽  
Min-Jae Jeong ◽  
Kyunghak Choi ◽  
...  
Keyword(s):  
Prosthetic Graft ◽  
Aortic Disease ◽  
Graft Replacement

Aortic disease: Aneurysm and dissection—role of MSCT

2021 ◽  
pp. 771-780
Author(s):  
Rocío Hinojar ◽  
Raimund Erbel
Keyword(s):  
Aortic Disease ◽  
Complete Characterization ◽  
Unexpected Finding ◽  
Aortic Diseases ◽  
Aortic Pathology ◽  
Life Threatening ◽  
Excellent Spatial Resolution ◽  
Widespread Availability

Multislice computed tomography (MSCT) is currently the preferred modality for diagnosis and complete characterization of aortic pathology because of its widespread availability, rapidity, excellent spatial resolution, and excellent accuracy for all aortic segments and different aortic diseases. Aortic disease often remains undiagnosed until a life-threatening complication occurs or the disease is an unexpected finding on imaging studies performed for other purposes. MSCT allows the measurement of the aortic wall and dimension and the evaluation of morphologic features and surrounding structures, even in very sick or unstable patients. It provides not only accurate and highly reproducible aortic measurements but also the evaluation of the wall and contents of an aneurysm, including thrombus, and surrounding structures.

Mycotic aneurysm of the descending thoracic aorta: The role of transesophageal echocardiography

1996 ◽  
Vol 9 (5) ◽  
pp. 663-667 ◽  
Author(s):  
Ian I. Joffe ◽  
Ronald P. Emmi ◽  
Jonathan Oline ◽  
Larry E. Jacobs ◽  
Alyson N. Owen ◽  
...  
Keyword(s):  
Transesophageal Echocardiography ◽  
Thoracic Aorta ◽  
Mycotic Aneurysm ◽  
Descending Thoracic Aorta

scholarly journals Sequential ruptures of penetrating atherosclerotic ulcers of ascending aorta, aortic arch and descending thoracic aorta

2020 ◽  
Vol 15 (1) ◽  
Author(s):  
Pankaj Kaul ◽  
Rodolfo Paniagua ◽  
Afroditi Petsa ◽  
Raj Singh
Keyword(s):  
Renal Cell Carcinoma ◽  
Case Report ◽  
Thoracic Aorta ◽  
Renal Cell ◽  
Ascending Aorta ◽  
Descending Thoracic Aorta ◽  
Graft Replacement ◽  
Penetrating Ulcer ◽  
Similarities And Differences ◽  
Aortic Dissections

Abstract Background Penetrating ulcers of aorta, aortic dissections and intramural hematomas all come under acute aortic syndromes and have important similarities and differences. Case report We report a 67 year old man with rupture of a large penetrating ulcer of the distal ascending aorta with hemopericardium and left hemothorax. He underwent interposition graft replacement of ascending aorta and hemi-arch with a 30 mm Gelweave Vascutek graft but represented 6 months later with development of a penetrating ulcer which ruptured into a huge 14 cm pseudoaneurysm. This was repaired with a 28 mm Vascutek Gelseal graft replacement of arch and interposition graft reconstruction of innominate and left common carotid arteries. 6 weeks later, however, he ruptured his proximal descending aorta and underwent TEVAR satisfactorily. Unfortunately, 2 days later, he developed a pathological fracture of left proximal tibia with metastasis from a primary renal cell carcinoma. He died 3 weeks later from respiratory failure. We shall briefly outline the similarities and differences in presentation and management of penetrating aortic ulcers, aortic dissections and intramural haematomas. We shall discuss, in greater detail, penetrating ulcers of thoracic aorta, their natural history, location, complications and management. Conclusion This case report is unique on account of initial successful surgical redressal following rupture of penetrating ulcer of distal ascending aorta into left pleural and pericardial cavities, normally associated with instant death. The haemodynamic effects of the rupture were staggered due to initial contained rupture into a smaller pseudoaneurysm, followed by a further rupture into a false aneurysmal sac followed eventually by generalised rupture into the pleural and pericardial cavities - a unique way of aortic rupture. Further development of another penetrating ulcer and a small pseudoaneurysm in the distal arch 6 months later which further ruptured into a larger 14 cm false aneurysmal sac, which again did not result in exsanguination, is again extraordinarily rare. Thereafter he underwent emergency thoracic endovascular aortic repair (TEVAR) for a further rupture of descending thoracic aorta. All three ruptures were managed successfully and would usually be associated with near-certain death, only for the patient to succumb eventually to the complications of metastatic renal cell carcinoma.

Endovascular Repair of the Descending Thoracic Aorta: Evidence for the Change in Clinical Practice

Vascular ◽  
2005 ◽  
Vol 13 (3) ◽  
pp. 148-157 ◽  
Author(s):  
Saiqa Sayed ◽  
Matt M. Thompson
Keyword(s):  
Thoracic Aorta ◽  
Endovascular Repair ◽  
Graft Infection ◽  
Aortic Disease ◽  
Outcome Data ◽  
Aortic Aneurysms ◽  
Descending Thoracic Aorta ◽  
Thoracic Aortic Disease ◽  
Technical Success Rate ◽  
Open Conversion

The purpose was to review outcome data following endovascular repair of the descending thoracic aorta from reports published between 1994 and 2004. To accomplish this task, 1,518 patients underwent endovascular repair for thoracic aortic disease; 810 thoracic aortic aneurysms, 500 type B thoracic aortic dissections, and 106 traumatic ruptures. The 30-day mortality rate was 5.5% and 6% for late postoperative deaths. The primary technical success rate was 97%, with only 15 patients requiring open conversion. Neurologic deficits occurred in 29 patients. In total, 118 endoleaks were reported; 29 were restented, and the remainder required surgical intervention. Graft infection occurred in 6 cases, and migrations were detected in 10. The conclusion reached is that endovascular repair of descending thoracic aortic disease is feasible and can be achieved with low rates of perioperative morbidity and mortality. As few long-term data exist on the durability of thoracic stent grafts, lifelong surveillance remains necessary.

scholarly journals Sequential ruptures of penetrating atherosclerotic ulcers of ascending aorta, aortic arch and descending thoracic aorta

2020 ◽  
Author(s):  
Pankaj Kaul ◽  
Rodolfo Paniagua ◽  
Afroditi Petsa ◽  
Raj Singh
Keyword(s):  
Renal Cell Carcinoma ◽  
Cell Carcinoma ◽  
Thoracic Aorta ◽  
Renal Cell ◽  
Ascending Aorta ◽  
Descending Thoracic Aorta ◽  
Graft Replacement ◽  
Interposition Graft ◽  
Penetrating Ulcer ◽  
Aortic Dissections

Abstract BackgroundPenetrating ulcers of aorta, aortic dissections and intramural hematomas all come under acute aortic syndromes and have important similarities and differences.Case ReportWe report a 67 year old man with rupture of a large penetrating ulcer of the distal ascending aorta with hemopericardium and left hemothorax. He underwent interposition graft replacement of ascending aorta and hemi-arch with a 30 mm Gelweave Vascutek graft but represented 6 months later with development of a penetrating ulcer which ruptured into a huge 14 cm pseudoaneurysm. This was repaired with a 28 mm Vascutek Gelseal graft replacement of arch and interposition graft reconstruction of innominate and left common carotid arteries. 6 weeks later, however, he ruptured his proximal descending aorta and underwent TEVAR satisfactorily. Unfortunately, 2 days later, he developed a pathological fracture of left proximal tibia with metastasis from a primary renal cell carcinoma. He died 3 weeks later from respiratory failure.We shall briefly outline the similarities and differences in presentation and management of penetrating aortic ulcers, aortic dissections and intramural haematomas. We shall discuss, in greater detail, penetrating ulcers of thoracic aorta, their natural history, location, complications and management.ConclusionThis case report is unique on account of initial successful surgical redressal following rupture of penetrating ulcer of distal ascending aorta into left pleural and pericardial cavities, normally associated with instant death. The haemodynamic effects of the rupture were staggered due to initial contained rupture into a smaller pseudoaneurysm, followed by a further rupture into a false aneurysmal sac followed eventually by generalised rupture into the pleural and pericardial cavities - a unique way of aortic rupture. Further development of another penetrating ulcer and a small pseudoaneurysm in the distal arch 6 months later which further ruptured into a larger 14 cm false aneurysmal sac, which again did not result in exsanguination, is again extraordinarily rare. Thereafter he underwent emergency thoracic endovascular aortic repair (TEVAR) for a further rupture of descending thoracic aorta. All three ruptures were managed successfully and would usually be associated with near-certain death, only for the patient to succumb eventually to the complications of metastatic renal cell carcinoma.

scholarly journals Role of the Cardiac Synchronised Computed Tomography Angiography in the Dissection of Descending Thoracic Aorta

2019 ◽  
Vol 58 (6) ◽  
pp. e622
Author(s):  
Chiara Ruggieri ◽  
Maria Ruffino ◽  
Simona Veglia ◽  
Domenica Garabello ◽  
Ottavio Davini ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Thoracic Aorta ◽  
Computed Tomography Angiography ◽  
Descending Thoracic Aorta

scholarly journals Role of the Cardiac-Synchronized Computed Tomography Angiography in Diagnosis and Follow-Up of the Dissection of Descending Thoracic Aorta

2020 ◽  
Author(s):  
Maria Antonella Ruffino ◽  
Chiara Ruggieri ◽  
Simona Veglia ◽  
Ottavio Davini ◽  
Paolo Fonio
Keyword(s):  
Computed Tomography ◽  
Thoracic Aorta ◽  
Computed Tomography Angiography ◽  
Descending Thoracic Aorta

Surgical and Long-term Outcome of Graft Replacement of Aneurysms of the Descending Thoracic Aorta: Analysis of 28 Consecutive Cases

1997 ◽  
Vol 31 (3) ◽  
pp. 141-145 ◽  
Author(s):  
Risto Pokela ◽  
Jari Satta ◽  
Tatu Juvonen ◽  
Jarmo Lahtinen ◽  
Martti Mosorin ◽  
...  
Keyword(s):  
Thoracic Aorta ◽  
Descending Thoracic Aorta ◽  
Graft Replacement ◽  
Term Outcome ◽  
Long Term Outcome

scholarly journals Factors influencing the expression of stress fibers in vascular endothelial cells in situ.

1983 ◽  
Vol 97 (2) ◽  
pp. 416-424 ◽  
Author(s):  
G E White ◽  
M A Gimbrone ◽  
K Fujiwara
Keyword(s):  
Endothelial Cells ◽  
Thoracic Aorta ◽  
Spontaneously Hypertensive Rats ◽  
Vascular Endothelial Cells ◽  
Stress Fibers ◽  
Vascular Endothelial ◽  
Descending Thoracic Aorta ◽  
Hypertensive Rats ◽  
Spontaneously Hypertensive

The organization of actin and myosin in vascular endothelial cells in situ was studied by immunofluorescence microscopy. Examination of perfusion-fixed, whole mounts of normal mouse and rat descending thoracic aorta revealed the presence of axially oriented stress fibers containing both actin and myosin within the endothelial cells. In both species, the proportion of cells containing stress fibers varied from region to region within the same vessel. Some endothelial cells in mouse mesenteric vein and in rat inferior vena cava also contained stress fibers. Quantitative studies of the proportion of endothelial cells containing stress fibers in the descending thoracic aorta of age-matched normotensive and spontaneously hypertensive rats revealed significant differences. When animals of the same sex of the two strains were compared, the proportion was approximately two times greater in the spontaneously hypertensive rats. The proportion of endothelial cells containing stress fibers was about two times greater in males than in females of both strains. These observations suggest that multiple factors, including anatomical, sex, and hemodynamic differences, influence the organization of the endothelial cell cytoskeleton in situ.

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