scholarly journals Efficacy of “Pinggan Formula” in Controlling Acute Type B Aortic Dissection Perioperative Blood Pressure: A Randomized Controlled Clinical Trial

2019 ◽  
Vol 2019 ◽  
pp. 1-8
Author(s):  
Hao Zhang ◽  
Danying Zhang ◽  
Yudong Sun ◽  
Ye Lu ◽  
Jiaxuan Feng ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Aortic Dissection ◽  
Antihypertensive Drugs ◽  
Perioperative Period ◽  
Control Group ◽  
Controlled Clinical Trial ◽  
Acute Type ◽  
Type B ◽  
Type B Aortic Dissection ◽  
Experimental Group

Objective. To explore a new treatment that can proceed from the whole, control blood pressure smoothly and coordinate the treatment of multiple factors causing blood pressure fluctuations. Method. We conducted a single-center, double-blinded, and randomized controlled clinical trial. 48 patients with acute Type B aortic dissection were randomly assigned into two groups: the experimental group, who received pinggan formula treatment, and the control group, who received placebo treatment. The drug was taken orally after meals three times a day. Only when the patients’ blood pressure fluctuated, conventional antihypertensive drugs were given to maintain the blood pressure within the target range and the dosage was recorded to convert the DDD value. Meanwhile, the international standardized score was used to evaluate the defecation, sleep, pain, anxiety, and depression of patients in the two groups during the hospitalization. Result. Univariate analysis was conducted on variables that might affect the assessment results, and it was found that grouping factors had a significant impact on the outcome variables, that is, after the intervention, the mean value of DDDs used in the perioperative period in the control group was 2.19 (0.38, 4.00). (P=0.0219), defecation score (2.13 (1.59, 2.67); P<0.0001), sleep score (0.95 (0.40, 1.50); P=0.0014), pain score (1.77 (0.61, 2.93); P=0.0045), depression score (4.04 (2.95, 5.12); and P<0.0001) were significantly higher than that of the experimental group, and the difference was statistically significant. Conclusion. Pinggan formula has a clear therapeutic regulation effect on the overall hemodynamics of acute Stanford type B aortic dissection during the perioperative period and can be recommended as an auxiliary drug for conventional antihypertensive drugs at the current stage.

Impact of high blood pressure variability on the occurrence of acute type B aortic dissection

Vascular ◽  
2020 ◽  
Vol 28 (4) ◽  
pp. 413-420
Author(s):  
Chao Song ◽  
Guanyu Yu ◽  
Xiang Feng ◽  
Rui Feng ◽  
Junmin Bao ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Aortic Dissection ◽  
High Blood Pressure ◽  
Blood Pressure Variability ◽  
False Lumen ◽  
Acute Type ◽  
Type B ◽  
Type B Aortic Dissection ◽  
Low Blood Pressure ◽  
Visceral Arteries

Background Acute type B aortic dissection is a life-threatening medical emergency, and hypertension is believed to be an important predictor of aortic dissection; the impact of blood pressure variability on the onset and development of aortic dissection has attracted increasing attention. Methods A total of 120 acute type B aortic dissection patients and 57 hypertensive patients without aortic dissection were consecutively enrolled and retrospectively reviewed between January 2013 and November 2015. There were 60 acute type B aortic dissection patients in both high and low blood pressure variability groups. Results Blood pressure variability showed higher diagnostic value than hypertension in aortic dissection, and the best threshold of blood pressure variability is 5.71 mmHg. By performing multivariable logistic regression, we found that the history of hypertension was likely to be a risk factor of blood pressure variability (95% CI: 1.155–6.422, P = 0.022). Nine patients from high blood pressure variability group and two from low blood pressure variability group ( χ2 = 4.90, P = 0.027) received emergency surgery within 24 hours after admission. The presence of multiple tears (>2, 55.0% vs. 45.0%, P = 0.001), configuration of the false lumen (spiral false lumen) (50.0% vs. 21.7%, P = 0.001), the diameter of the false lumen (49.6 ± 15.0 mm vs. 37.6 ± 10.8 mm, P < 0.001), the false/true lumen ratio (1.53 ± 1.02 vs. 0.929 ± 0.733, P < 0.001), and the number of visceral arteries involved (1.75 ± 0.942 vs. 0.800 ± 0.927, P < 0.001) showed significant differences between high and low blood pressure variability groups. Nine (30%) patients from the high blood pressure variability group showed a maximum diameter of false lumen over 60 mm, while none was found in the low blood pressure variability group. Conclusions High blood pressure variability, the presence of multiple tears (>2), the configuration of false lumen, the diameter of the false lumen, false/true lumen ratio, and the number of visceral arteries involved were independent risk factors for acute type B aortic dissection.

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

2009 ◽  
Vol 150 (3) ◽  
pp. 129-131 ◽  
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.

Endovascular Therapy for Nonischemic vs Ischemic Complicated Acute Type B Aortic Dissection

2019 ◽  
Vol 27 (1) ◽  
pp. 145-152 ◽  
Author(s):  
Ahmed Eleshra ◽  
Tilo Kölbel ◽  
Giuseppe Panuccio ◽  
Fiona Rohlffs ◽  
E. Sebastian Debus ◽  
...  
Keyword(s):  
Aortic Dissection ◽  
Uncontrolled Hypertension ◽  
Aortic Dilatation ◽  
Acute Type ◽  
Type B ◽  
Type B Aortic Dissection ◽  
Ischemic Group ◽  
Atherosclerotic Stenosis ◽  
Significant Difference ◽  
Branch Vessel

Purpose: To report a single-center experience with thoracic endovascular aortic repair (TEVAR) for complicated acute type B aortic dissection (cATBAD) comparing patients with vs without end-organ ischemia. Materials and Methods: Between November 2010 and December 2017, 64 patients (mean age 64.8±12.5 years; 49 men) underwent TEVAR for cATBAD. Patients were grouped into 2 cohorts: nonischemic (39, 61%) patients with unrelenting pain, early progressive aortic dilatation, uncontrolled hypertension, or rupture, and ischemic (25, 39%) patients with visceral, renal, lower extremity, or spinal cord hypoperfusion. Results: Mean time from diagnosis to treatment was 7.5 days (range 1–32) in the nonischemic group vs 2.3 days (range 1–14) days in the ischemic group (p=0.007). Fourteen (56%) of 25 ischemic cATBAD patients had stents implanted in the renovascular branch vessels, while 4 (16%) patients had stents implanted in the iliac arteries. When branch vessel cannulation failed, fenestrations were made in the intimal flap to improve perfusion of the involved branch (n=5). In the nonischemic group, 3 arteries were stented owing to atherosclerotic stenosis. Technical success was achieved in 62 (97%) of 64 patients; despite stenting, 2 patients had low renal artery perfusion on final angiography. There were no statistically significant differences in early or late outcomes between the nonischemic vs ischemic cATBAD patients. Six (9%) patients died within 30 days: 2 (5%) in the nonischemic group vs 4 (16%) in the ischemic group. Major complications (1 stroke, 2 cases of paraplegia, 1 retrograde type A dissection, and 1 case of bowel ischemia) occurred only in the nonischemic group. The mean follow-up was 28 months. Late endoleaks were observed in 3 (8%) nonischemic patients and 1 (4%) ischemic patient. Reinterventions were required in 7 (18%) nonischemic patients and 4 (16%) ischemic patients. Conclusion: TEVAR is an effective and safe method of treating cATBAD. Early intervention in ischemic cATBAD may have played a significant role in the lack of significant difference between ischemic and nonischemic cATBAD outcomes. Direct visceral reperfusion through branch vessel stenting during TEVAR may be crucial in achieving good outcomes in ischemic cATBAD.

scholarly journals Acute type B aortic dissection: update on proper management

2014 ◽  
Vol 3 (4) ◽  
pp. 258-264 ◽  
Author(s):  
Georgios Geropapas ◽  
George Galyfos ◽  
Ioannis Stefanidis ◽  
Ioannis Stamatatos ◽  
Stavros Kerasidis ◽  
...  
Keyword(s):  
Aortic Dissection ◽  
Acute Type ◽  
Type B ◽  
Type B Aortic Dissection ◽  
Proper Management

The Impact of Arch Involvement in Acute Type B Aortic Dissection

2017 ◽  
Vol 41 ◽  
pp. 28-29
Author(s):  
Hunter M. Ray ◽  
Kristofer M. Charlton-Ouw ◽  
Anthony L. Estrera ◽  
Charles C. Miller ◽  
Hazim J. Safi ◽  
...  
Keyword(s):  
Aortic Dissection ◽  
Acute Type ◽  
Type B ◽  
Type B Aortic Dissection ◽  
The Impact
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