scholarly journals Surgical Management of Ascending Aortic Aneurysm and Its Complications

2014 ◽  
Vol 2014 ◽  
pp. 1-3
Author(s):  
Sisira Sran ◽  
Manpreet Sran ◽  
Nicole Ferguson ◽  
Amgad N. Makaryus
Keyword(s):  
Open Surgery ◽  
Innominate Artery ◽  
Aortic Aneurysms ◽  
Dacron Graft ◽  
Ascending Aortic Aneurysm ◽  
Pseudoaneurysm Formation ◽  
Aortic Pathology ◽  
Surgical Options ◽  
The Right ◽  
Continuous Bleeding

Ascending aortic aneurysms involving the proximal aortic arch, arising anywhere from the aortic valve to the innominate artery, represent various problems in which open surgery is generally required. Surgical options include excision of the aortic pathology or wrapping the aneurysm shell with an aortic Dacron graft. Intervention using the latter method can lead to extravasation of blood along the suture lines resulting in continuous bleeding within the periprosthetic space. The Cabrol technique was developed as a method for decompression of postoperative leaks by the formation of a conduit system from the periprosthetic space to the right atrium. The coronary ostia are anastomosed to a second graft in an end-to-end fashion, which is then anastomosed to the ascending aortic conduit side to side. The native aorta is then sewn around the prosthesis, hereby creating a shunt to drain anastomotic leakage. This shunt reduces postsurgical risk of pseudoaneurysm formation and normally closes a few days following surgery. We discuss the case of a patient who underwent Cabrol’s variation and six months later was demonstrated to have a patent shunt.

scholarly journals Innominate artery aneurysm, how to solve it?

2017 ◽  
Vol 45 (3) ◽  
pp. 1279-1284 ◽  
Author(s):  
Xiao-Long Wang ◽  
Xin-Liang Guan ◽  
Wen-Jian Jiang ◽  
Ou Liu ◽  
Hong-Jia Zhang
Keyword(s):  
Computed Tomography ◽  
Computed Tomography Angiography ◽  
Work Experience ◽  
Median Sternotomy ◽  
Artery Aneurysm ◽  
Innominate Artery ◽  
Ascending Aorta ◽  
Dacron Graft ◽  
Postoperative Course ◽  
The Right

We herein describe our *These authors contributed equally to this work. experience with a congenital innominate artery aneurysm (IAA) that was managed with a simple surgical procedure. A 44-year-old woman was admitted for chest distress. Computed tomography angiography showed a 3.6-cm IAA arising from the aortic arch and compressing the trachea. A median sternotomy was performed with the patient under general anesthesia, and the IAA was found to involve the origin of the innominate artery and the bifurcation of the right subclavian artery and common carotid artery; however, the aorta was intact. An 8-mm Dacron graft was anastomosed to the ascending aorta and distal end of the IAA without cardiopulmonary bypass. The postoperative course was uneventful, and repeat computed tomography angiography revealed no evidence of recurrence 6 months postoperatively. We also herein present a literature review of this rare clinical condition.

Covered Endovascular Repair of Innominate Artery Bifurcation After Thoracic Blunt Trauma

2020 ◽  
pp. 153857442097647
Author(s):  
António Pereira-Neves ◽  
Ricardo Gouveia ◽  
Marina Dias-Neto ◽  
Luís Duarte-Gamas ◽  
João Rocha-Neves ◽  
...  
Keyword(s):  
Open Surgery ◽  
Innominate Artery ◽  
Good Alternative ◽  
High Energy ◽  
Morbidity And Mortality ◽  
Blunt Injury ◽  
Stent Patency ◽  
Perioperative Morbidity ◽  
Pseudoaneurysm Formation ◽  
Brachiocephalic Trunk

Innominate artery (IA) injury is a rare entity with most patients dying before reaching the hospital. While open surgery remains the standard treatment, the endovascular approach is attractive as it may reduce perioperative morbidity and mortality. We report a case of IA blunt injury extending to the subclavian artery with pseudoaneurysm formation successfully treated with covered stenting of IA and its bifurcation. A 49-year-old male was admitted after suffering multiple trauma due to a high energy impact motorcycle crash. In the emergency room, the patient was hypotensive with a Glasgow coma score of 15. On physical examination, he had right peri-orbital ecchymosis, left otorrhagia and an open patella fracture. The computed tomographic angiography (CTA) revealed enlargement of the mediastinum and a 29 mm pseudoaneurysm involving the right brachiocephalic trunk and its bifurcation. Under general anesthesia, a covered balloon-expandable stent (CBES) was then placed in the IA followed by kissing stent of its bifurcation with an additional 2 covered balloon-expandable stents. Final subtraction angiography demonstrated complete pseudoaneurysm exclusion and stent patency without additional complications. No neurologic deficits or other intervention-related complications were found in the postoperative period. At 10 months follow-up, the patient remained asymptomatic and with palpable distal pulses. Endovascular management of IA injury may provide a good alternative to open surgery with low perioperative morbidity and mortality.

Penetrating atherosclerotic ulcer aneurysm of the innominate artery

VASA ◽  
2009 ◽  
Vol 38 (3) ◽  
pp. 263-266 ◽  
Author(s):  
Yuan ◽  
Tager
Keyword(s):  
Conservative Treatment ◽  
Thoracic Aorta ◽  
Open Surgery ◽  
Innominate Artery ◽  
Ruptured Aneurysm ◽  
Descending Thoracic Aorta ◽  
Penetrating Atherosclerotic Ulcer ◽  
Descending Aorta

Penetrating atherosclerotic ulcer of the aorta is uncommon, and usually develops in the descending thoracic aorta. Rarely this condition involves the branch vessels of the aorta. We report a case of ruptured aneurysm of the innominate artery resulting from penetrating atherosclerotic ulcer. Open surgery was the treatment of choice for the ruptured aneurysm, while conservative treatment was recommended for the associated penetrating atherosclerotic ulcers of the descending aorta.

Epigenetic Profiling Identifies Novel Genes for Ascending Aortic Aneurysm Formation with Bicuspid Aortic Valves

2015 ◽  
Vol 18 (4) ◽  
pp. 134 ◽  
Author(s):  
Asad A Shah
Keyword(s):  
Gene Expression ◽  
Aortic Aneurysm ◽  
Methylation Status ◽  
Aortic Aneurysms ◽  
Aortic Valves ◽  
Ascending Aortic Aneurysm ◽  
Novel Genes ◽  
Aneurysm Formation ◽  
Aortic Replacement ◽  
Bicuspid Aortic Valves

<p><strong>Background:  </strong>Bicuspid aortic valves predispose to ascending aortic aneurysms, but the mechanisms underlying this aortopathy remain incompletely characterized.  We sought to identify epigenetic pathways predisposing to aneurysm formation in bicuspid patients.</p><p><strong>Methods:  </strong>Ascending aortic aneurysm tissue samples were collected at the time of aortic replacement in subjects with bicuspid and trileaflet aortic valves.  Genome-wide DNA methylation status was determined on DNA from tissue using the Illumina 450K methylation chip, and gene expression was profiled on the same samples using Illumina Whole-Genome DASL arrays.  Gene methylation and expression were compared between bicuspid and trileaflet individuals using an unadjusted Wilcoxon rank sum test.  </p><p><strong>Results:  </strong>Twenty-seven probes in 9 genes showed significant differential methylation and expression (P&lt;5.5x10<sup>-4</sup>).  The top gene was protein tyrosine phosphatase, non-receptor type 22 (<em>PTPN22</em>), which was hypermethylated (delta beta range: +15.4 to +16.0%) and underexpressed (log 2 gene expression intensity: bicuspid 5.1 vs. trileaflet 7.9, P=2x10<sup>-5</sup>) in bicuspid patients, as compared to tricuspid patients.  Numerous genes involved in cardiovascular development were also differentially methylated, but not differentially expressed, including <em>ACTA2</em> (4 probes, delta beta range:  -10.0 to -22.9%), which when mutated causes the syndrome of familial thoracic aortic aneurysms and dissections</p><p><strong>Conclusions:  </strong>Using an integrated, unbiased genomic approach, we have identified novel genes associated with ascending aortic aneurysms in patients with bicuspid aortic valves, modulated through epigenetic mechanisms.  The top gene was <em>PTPN22</em>, which is involved in T-cell receptor signaling and associated with various immune disorders.  These differences highlight novel potential mechanisms of aneurysm development in the bicuspid population.</p>

scholarly journals Aggrecan: a new biomarker for acute type A aortic dissection

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Karl C. König ◽  
Harald Lahm ◽  
Martina Dreßen ◽  
Stefanie A. Doppler ◽  
Stefan Eichhorn ◽  
...  
Keyword(s):  
Aortic Dissection ◽  
Troponin T ◽  
Type A ◽  
Aortic Aneurysms ◽  
Aortic Tissue ◽  
Acute Type ◽  
Type A Aortic Dissection ◽  
Potential Biomarker ◽  
Aortic Pathology ◽  
Creatine Kinase Mb

AbstractAcute type A aortic dissection (ATAAD) constitutes a life-threatening aortic pathology with significant morbidity and mortality. Without surgical intervention the usual mortality rate averages between 1 and 2% per hour. Thus, an early diagnosis of ATAAD is of pivotal importance to direct the affected patients to the appropriate treatment. Preceding tests to find an appropriate biomarker showed among others an increased aggrecan (ACAN) mRNA expression in aortic tissue of ATAAD patients. As a consequence, we investigated whether ACAN is a potential biomarker for diagnosing ATAAD. Mean ACAN protein concentration showed a significantly higher plasma concentration in ATAAD patients (38.59 ng/mL, n = 33) compared to plasma of patients with thoracic aortic aneurysms (4.45 ng/mL, n = 13), patients with myocardial infarction (11.77 ng/mL, n = 18) and healthy volunteers (8.05 ng/mL, n = 12). Cardiac enzymes like creatine kinase MB and cardiac troponin T showed no correlation with ACAN levels in ATAAD patients. Receiver-operator characteristics (ROC) curve analysis for ATAAD patients versus control subjects an optimum discrimination limit of ACAN plasma levels at 14.3 ng/mL with a corresponding sensitivity of 97% and specificity of 81%. According to our findings ACAN is a reliable potential biomarker in plasma samples to detect ATAAD with high sensitivity and specificity.

OP-043 Quality of Life After Endovascular Repair Versus Open Surgery for Abdominal Aortic Aneurysms

2016 ◽  
Vol 117 ◽  
pp. S17-S18
Author(s):  
Emre Gök ◽  
Mehmet Akif Onalan ◽  
Metin Onur Beyaz ◽  
Celalettin Karatepe ◽  
Bayer Cinar ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Endovascular Repair ◽  
Open Surgery ◽  
Abdominal Aortic Aneurysms ◽  
Aortic Aneurysms ◽  
Abdominal Aortic

Giant Pseudoaneurysm of the Extracranial Vertebral Artery Successfully Treated Using Intraoperative Balloon Catheters

Neurosurgery ◽  
1991 ◽  
Vol 28 (5) ◽  
pp. 738-742 ◽  
Author(s):  
Junya Hanakita ◽  
Hideyuki Suwa ◽  
Kiyoshi Nishihara ◽  
Koji Iihara ◽  
Hiroshi Sakaida
Keyword(s):  
Vertebral Artery ◽  
Cardiac Pacemaker ◽  
Innominate Artery ◽  
Anatomical Location ◽  
High Morbidity ◽  
Vertebrobasilar System ◽  
Balloon Catheters ◽  
Extracranial Vertebral Artery ◽  
The Right ◽  
Giant Pseudoaneurysm

Abstract Traumatic pseudoaneurysms of the extracranial vertebral artery rarely occur, because of its deeply protected anatomical location. Because the direct surgical approach has resulted in high morbidity and mortality rates, ligation of the vertebral artery has been adopted, but this can cause an ischemia in the vertebrobasilar system. We report the case of a 73-year-old woman with a huge pseudoaneurysm of the right vertebral artery that occurred after attempted placement of a cardiac pacemaker. The aneurysm was 7 x 7 x 5 cm in size and its neck was situated just distal to the right subclavian artery. Direct surgical repair of the injured vessel and removal of the aneurysm were successfully performed using balloon catheters placed intraoperatively in both the innominate artery and the right vertebral artery.

scholarly journals A comparison of open surgery versus endovascular repair of unstable ruptured abdominal aortic aneurysms

2014 ◽  
Vol 60 (6) ◽  
pp. 1439-1445 ◽  
Author(s):  
Prateek K. Gupta ◽  
Bala Ramanan ◽  
Travis L. Engelbert ◽  
Girma Tefera ◽  
John R. Hoch ◽  
...  
Keyword(s):  
Endovascular Repair ◽  
Open Surgery ◽  
Abdominal Aortic Aneurysms ◽  
Aortic Aneurysms ◽  
Abdominal Aortic ◽  
Ruptured Abdominal Aortic Aneurysms
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