A two-fluid blood stasis model for false lumen thrombosis after type B dissection repair

Introduction Predicting aortic growth in acute type B dissection is fundamental in planning interventions. Several factors are considered to be growth predictors in the literature and, among them, size and location of entry tears have been recognized to particularly influence the false lumen pressure. In this study, we develop an in vitro setting to analyze the actual impact of size and location of the entry tears on false lumen pressure, in the absence of other confounding factors such as the deformability of the aortic wall. Methods We formalize some indexes that synthetically describe the false lumen pressure with respect to the true lumen pressure. Then, we experimentally derive their values in several configurations of the in vitro setting, and we look for trends in the indexes with respect to the size and location of entry tears. Results: Results show that the tears have a relevant impact on the false lumen pressure, but that their size and location alone are not enough to explain the phenomena observed in vivo. Conclusions To predict the behavior of acute type B dissection, we therefore recommend not limiting to size and location, as many effects may derive from the interactions between these parameters and other patient characteristics.

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Predictor of false lumen thrombosis after thoracic endovascular aortic repair for type B dissection

Journal of Thoracic and Cardiovascular Surgery ◽

10.1016/j.jtcvs.2019.07.091 ◽

2020 ◽

Vol 160 (2) ◽

pp. 360-367 ◽

Cited By ~ 1

Author(s):

Da Li ◽

Liqing Peng ◽

Yi Wang ◽

Jichun Zhao ◽

Ding Yuan ◽

...

Keyword(s):

False Lumen ◽

Thoracic Endovascular Aortic Repair ◽

Endovascular Aortic Repair ◽

Type B ◽

Aortic Repair ◽

Type B Dissection

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How to Exclude the Dilated False Lumen in Patients after a Type B Aortic Dissection? The Cork in the Bottleneck

Journal of Endovascular Therapy ◽

10.1177/152660280301000213 ◽

2003 ◽

Vol 10 (2) ◽

pp. 244-248 ◽

Cited By ~ 16

Author(s):

Maartje C. Loubert ◽

Victor P.M. van der Hulst ◽

Cees De Vries ◽

Kees Bloemendaal ◽

Anco C. Vahl

Keyword(s):

Aortic Dissection ◽

Stent Graft ◽

Case Reports ◽

False Lumen ◽

Type B ◽

Type B Aortic Dissection ◽

Type B Dissection ◽

Occluder Device ◽

Stent Graft Implantation ◽

Graft Implantation

Purpose: To report techniques for excluding the dilated false lumen associated with chronic type B aortic dissection following placement of a stent-graft in the true lumen. Case Reports: Two patients underwent stent-graft implantation for a dilated false lumen after chronic aortic dissection, but the false lumen was not excluded from the circulation by this procedure. The false lumen was obliterated in one case with Greenfield filters and detachable balloons placed above a renal artery orifice that was perfused via the false lumen. This acted like “a cork in the bottleneck” to block retrograde flow into the thoracic portion of the false lumen above the blockade. In the other patient, an occluder device was used as the “cork.” In both cases, a good result was obtained. The occluder device is preferred because deployment is more controllable. Conclusions: An occluder device may be used like a cork in a bottle to exclude the dilated false lumen in the thoracic aorta after a type B dissection.

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Toronto PowerWire fenestration technique to access false lumen branches in fenestrated endovascular aneurysm repair for chronic type B dissection

Journal of Vascular Surgery ◽

10.1016/j.jvs.2018.06.200 ◽

2019 ◽

Vol 69 (1) ◽

pp. 249-252 ◽

Cited By ~ 1

Author(s):

Steffan Frosi Stella ◽

Thomas F. Lindsay ◽

Kong T. Tan

Keyword(s):

Endovascular Aneurysm Repair ◽

False Lumen ◽

Type B ◽

Chronic Type ◽

Type B Dissection ◽

Aneurysm Repair

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4D flow MRI of type B dissection with later retrograde progression to type A dissection in Marfan: a case report

European Heart Journal - Case Reports ◽

10.1093/ehjcr/ytab288 ◽

2021 ◽

Vol 5 (8) ◽

Author(s):

Max J P van Hout ◽

Joe F Juffermans ◽

Arthur J Scholte ◽

Hildo J Lamb

Keyword(s):

Risk Assessment ◽

Subclavian Artery ◽

Left Subclavian Artery ◽

False Lumen ◽

Type A ◽

Acute Type ◽

Type B ◽

4D Flow ◽

Type B Dissection ◽

Type A Dissection

Abstract Background Due to the malfunction of connective tissue, Marfan patients are at increased risk of aortic dissection. Uncomplicated acute type B dissection is usually managed with medical therapy. Retrograde progression or new type A dissection is a relatively rare but often fatal complication that occur most frequently in the first 6 months after acute type B dissection. Case summary We present a 31-year-old male with Marfan syndrome and a recent uncomplicated type B dissection from the left subclavian to the right common iliac artery who underwent 4D flow magnetic resonance imaging (MRI). The dissection had a large proximal intimal tear just distal to the left subclavian artery (15 mm) and large false lumen (35 mm). Aortic blood flow just distal to the left subclavian artery (3.6 L/min) was split disproportionately into the true (0.8 L/min, 22%) and false lumen (2.8 L/min, 78%). 4D flow streamlines revealed vortical flow in the proximal false lumen. Increased wall shear stress was observed at the sinotubular junction (STJ), inner wall of the ascending aorta and around the subclavian artery. Two weeks after MRI, the patient presented with jaw pain. Computed tomography showed a type A dissection with an entry tear at the STJ for which an acute valve-sparing root, ascending and arch replacement was performed. Discussion Better risk assessment of life-threatening complications in uncomplicated type B dissections could improve treatment strategies in these patients. Our case demonstrates that besides clinical and morphological parameters, flow derived parameters could aid in improved risk assessment for retrograde progression from uncomplicated type B dissection to acute type A dissection.

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Abstract 102: Number of Reentry Tears Influences Flap Motion and Flow Reversal in an in vitro Model of Type B Aortic Dissection

Arteriosclerosis Thrombosis and Vascular Biology ◽

10.1161/atvb.36.suppl_1.102 ◽

2016 ◽

Vol 36 (suppl_1) ◽

Author(s):

Joav Birjiniuk ◽

Mark Young ◽

Lucas H Timmins ◽

Bradley G Leshnower ◽

John N Oshinski ◽

...

Keyword(s):

Aortic Dissection ◽

False Lumen ◽

Flow Reversal ◽

Patient Specific ◽

Type B ◽

True Lumen ◽

Flow Rates ◽

Custom Made ◽

Type B Dissection

Objectives: Aortic remodeling after dissection is poorly understood. Thus, optimal patient-specific recommendations for treatment are lacking. An in vitro aortic model of Type B dissection was used to interrogate local aortic hemodynamic parameters implicated in thrombosis and aneurysm formation. We hypothesize that dissections with multiple reentry tears will exhibit decreased flap motion, and, as a result, reduce flow reversal. Methods: Anatomic models of aortic dissection with fidelity to patient CT images were fabricated out of silicone. Models with primary entry and single fenestration (Figure 1A), two fenestrations (Figure 1B), and three fenestrations (Figure 1C) were installed in a flow loop. Physiologic flow was established at a cardiac index of 4 L/min. Flow velocities were acquired using phase contrast magnetic resonance (PCMR) imaging. Flow rates and flap motion were quantified using custom made software. Results: Relative true lumen area (RTLA) varied along the dissection (entry: 55% +/- 3, middle: 34% +/-7, exit: 91%+/-3, p<0.00001 pair-wise for 2-tear model). At mid-dissection, RTLA was lower in dissections with fewer tears (p<0.01). Total flow was nearly identical in all cases, while true and false lumen flow rates differed significantly across tear configurations and along the dissection (p<0.01). Secondary tears allowed for flow communication within the dissected portion of the aortic model. Flow reversal was seen in the false lumen at the mid-dissection plane in the absence of secondary tears (Figure 1D). However, as secondary tears were added, the flow reversal in the false lumen decreased, with concomitant flow reversal in the true lumen (Figure 1E,F). Conclusions: Anatomic characteristics of dissection, such as number of tears, affect blood flow and motion of the dissection flap, as shown quantitatively. This compliant aorta model illustrates alterations in flow reversal in both true and false lumina that may lead to aneurysmal degeneration.

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Fate of the Dissected Thoraco-Abdominal Aorta Distal to TEVAR (Thoracic Endovascular Aortic Repair) for Complicated Acute and Subacute Type B Aortic Dissection

Journal of Endovascular Therapy ◽

10.1177/15266028211065964 ◽

2021 ◽

pp. 152660282110659

Author(s):

Jowan Nassib ◽

Kheira Hireche ◽

Baris Ata Ozdemir ◽

Pierre Alric ◽

Ludovic Canaud

Keyword(s):

Morphological Changes ◽

False Lumen ◽

Thoracic Endovascular Aortic Repair ◽

Endovascular Aortic Repair ◽

Type B ◽

Descending Aorta ◽

Aortic Repair ◽

Aneurysmal Dilation ◽

Type B Dissection

Purpose: This study assessed morphological changes in the aortic true and false lumens during follow-up of patients undergoing TEVAR (Thoracic Endovascular Aortic Repair) for complicated acute and subacute type B dissection. The study analyzes the effectiveness of TEVAR in preventing distal aneurysmal progression. Materials and Methods: All patients between 2009 and 2019 undergoing TEVAR for complicated acute and subacute type B dissection at the study institution were retrospectively reviewed. Maximal diameters were measured on the proximal descending aorta right below the left subclavian artery, thoraco-abdominal junction right above the celiac trunk, and infrarenal aortic right above the inferior mesenteric artery, pre-operatively and during follow-up, analyzing either expansion or shrinkage of true and false lumens at these 3 sites. Results: Forty-one patients were included. Thirty-day incidence of death, stroke, paraplegia, and visceral ischemia was, respectively, 8% (n = 4), 6% (n = 3), 2% (n = 1), and 2% (n = 1). Three patients (6%) died from intervention-related cause. Mortality was 17% (n = 8) during a mean follow-up of 54 months. One patient had aneurysmal dilation of the descending aorta needing additional coverage and only 2 (4%) developed thoraco-abdominal aneurysms requiring re-intervention. In the remaining patients, both significant expansion of the true lumen and shrinkage of false lumen were observed at all 3 sites. Conclusion: Proximal coverage of the main entry tear appears to prevent aneurysmal progression in most patients (96%). With such promising results, TEVAR should be considered as a first-line treatment in acute and subacute type B dissection.

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Coil Embolization of an Aneurysmal Type B Dissection Persistent False Lumen after Visceral Hybrid Repair

Journal of Vascular and Interventional Radiology ◽

10.1016/j.jvir.2008.09.028 ◽

2009 ◽

Vol 20 (1) ◽

pp. 130-132 ◽

Cited By ~ 9

Author(s):

Celia Riga ◽

Colin Bicknell ◽

Michael Jenkins ◽

Mohamad Hamady

Keyword(s):

Coil Embolization ◽

False Lumen ◽

Type B ◽

Type B Dissection ◽

Hybrid Repair

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Management of Acute Uncomplicated Stanford B Aortic Dissection in The Era of Endovascular Repair: A Case Report

Heart Science Journal ◽

10.21776/ub.hsj.2020.001.03.8 ◽

2020 ◽

Vol 1 (3) ◽

pp. 36-40

Author(s):

Putri Annisa Kamila ◽

Novi Kurnianingsih ◽

Sasmojo Widito ◽

Djanggan Sargowo ◽

Budi Satrijo

Keyword(s):

Aortic Dissection ◽

Femoral Artery ◽

Endovascular Repair ◽

False Lumen ◽

Long Term Results ◽

Type B ◽

Type B Aortic Dissection ◽

Medication Therapy ◽

Type B Dissection ◽

Stanford B

Introduction: Uncomplicated type B aortic dissections have been traditionally treated with medication therapy. While it may provide good short-term results, longterm prognosis may be less favorable. With improvements in endovascular repair and the potential risk of disease progression, thoracic endovascular aortic repair (TEVAR) has been considered inpatients with uncomplicated type B aortic dissection. We present the case of 78-year-old gentleman who presented with acute uncomplicated type B aortic dissection managed by endovascular repair Case illustration: A 78 year-old hypertensive patient admitted to the hospital with persistent chest discomfort and cough for 2 weeks. The CT aortic angiogram showed type B dissection. Based on the recent guidelines, TEVAR should be considered in patients with uncomplicated type B aortic dissection, thus we prepared the patient for TEVAR procedure. First we established multidisciplinary vascular team for the pre-procedural preparation of the patient. We perform careful measurement through detailed CT angiography reconstruction from carotid to femoral arteries. We found proximal diameter was 30-35mm, distal diameter was 23mm and landing zone right after left brachial ostium, suitable for stent graft Valiant Captivia 36-32x150mm. The CT also showed that both femoral artery were normal, we decided to use right femoral artery as the access. We proceed to the procedure 2 days later, under general anaesthesia, digital subtraction angiography revealed dissection of descending aorta, and selected device was inserted. Subsequent contrast injection revealed total occlusion of the false lumen. Patient was transferred to ICU for postprocedural care, and extubated the day after. The hospital stay was uneventful, and one-month follow up CT shows no endoleak. Conclusion : Management of uncomplicated Stanford B dissections is very challenging. TEVAR has emerged as an alternative to surgery with lower morbidity and mortality rates that might offer good long-term results.

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Outcomes and aortic remodelling after proximal thoracic endovascular aortic repair of post type B aortic dissection thoracic aneurysm

VASA ◽

10.1024/0301-1526/a000546 ◽

2016 ◽

Vol 45 (4) ◽

pp. 331-336 ◽

Cited By ~ 5

Author(s):

Zhenyu Shi ◽

Jun Yang ◽

Weiguo Fu ◽

Daqiao Guo ◽

Xin Xu ◽

...

Keyword(s):

Aortic Dissection ◽

False Lumen ◽

Thoracic Endovascular Aortic Repair ◽

Endovascular Aortic Repair ◽

Maximum Diameter ◽

Thoracic Aneurysm ◽

Type B ◽

Type B Aortic Dissection ◽

Aortic Repair ◽

Type B Dissection

Abstract. Background: The objective was to explore the outcomes and aortic remodelling after proximal thoracic endovascular aortic repair (TEVAR) in post type B aortic dissection thoracic aneurysm with a maximal diameter ≥ 5.5cm. Patients and methods: 34 cases of type B aortic dissection thoracic aneurysm undergoing proximal TEVAR (coverage of the primary entry and the aneurysm extent) from 2008 to 2013 were retrospectively reviewed with follow-up for at least 2 years. The primary endpoints were 30-day mortality and survival at 2 years. The secondary endpoints were major complication and re-intervention. The aortic remodelling was investigated by comparison of the maximum diameter of the aneurysm and the diameter of true and false lumen at the same level between baseline and 2 years after TEVAR. Besides, we also analysed the possible relevant factors of aortic remodelling including the course of dissection, the involvement of dissection, and the length and shape of the stent graft. Results: The 30 day mortality was 2.9 % (1/34). The paraplegia rate post-TEVAR was 2.9 % (1/34). Overall, 32 out of the 34 cases were followed-up for 24 - 79 months. At 2 years, the overall and aortic specific survival were 87.5 % and 90.3 % respectively. The two year freedom from re-intervention rate was 87.5 %. Compared to the preoperative data, maximum diameter of descending aorta at 2 years demonstrated a slight increase (65.4±14.1mm Vs 63.9±9.1mm), but without significance (P>0.05). Meanwhile, we noticed a significant increase of true lumen (P < 0.01) and decrease of false lumen (P < 0.01) at the same level. Relevant analysis showed that positive aortic remodelling of the maximum diameter was associated with chronic phase (≥ 90 days of dissection onset) (P < 0.05) and the application of 150 - 170mm stent grafts (P < 0.05). Conclusions: Proximal TEVAR of post type B dissection thoracic aneurysm had generally favourable short- and mid-term outcomes with low paraplegia rate. Besides, it can achieve a certain extent of aortic remodelling.

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