Intravascular Ultrasound–Assisted Endovascular Treatment of Mesenteric Malperfusion in a Multichannel Aortic Dissection With Full True Lumen Collapse

Purpose: To describe endovascular treatment of mesenteric malperfusion in a multichannel aortic dissection (MCAD) with full true lumen (TL) collapse following thoracic endovascular aortic repair (TEVAR). Case Report: A 54-year-old man presented with chronic mesenteric ischemia and a previous TEVAR for MCAD complicated by superior mesenteric artery (SMA) malperfusion. Computed tomography angiography (CTA) demonstrated a 3-channel aortic dissection with a “false-true-false” configuration. The SMA was malperfused through the collapsed TL. CTA also showed a secondary entry tear, measuring 18 mm in diameter, at the end of the previous endograft. Direct open surgery or endovascular revascularization of the SMA was not feasible. A plan was devised to improve SMA perfusion by increasing the TL inflow. With the assistance of intravascular ultrasound (IVUS), an endograft was placed through one false lumen in the abdominal aorta and through the TL in the descending thoracic aorta to seal the secondary entry tear. Symptoms of mesenteric ischemia resolved 2 days after the procedure. At 1 year, he is asymptomatic, has gained weight, and has improved SMA perfusion and remodeling of the 3-channel dissection on CTA. Conclusion: IVUS imaging can help evaluate the complex hemodynamics of MCAD. Patient-specific endovascular treatment of MCAD with mesenteric malperfusion seems to be a feasible bailout alternative treatment for urgent, complex cases without reconstruction options.

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Endovascular treatment of persistent true lumen collapse of the descending aorta after open surgery for acute aortic dissection type A

The Thoracic and Cardiovascular Surgeon ◽

10.1055/s-0031-1297448 ◽

2012 ◽

Vol 60 (S 01) ◽

Author(s):

M Doemland ◽

E Weigang ◽

B Dorweiler ◽

F Dünschede ◽

MB Pitton ◽

...

Keyword(s):

Aortic Dissection ◽

Endovascular Treatment ◽

Open Surgery ◽

Acute Aortic Dissection ◽

Type A ◽

True Lumen ◽

Descending Aorta ◽

True Lumen Collapse ◽

Aortic Dissection Type A

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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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Endovascular Treatment of Distal False Lumen Aneurysmal Expansion in Chronic Type B Aortic Dissection with True Lumen Occlusion

Annals of Vascular Surgery ◽

10.1016/j.avsg.2020.02.027 ◽

2020 ◽

Vol 67 ◽

pp. 564.e1-564.e4

Author(s):

Mingwei Wu ◽

Yuxi Zhao ◽

Zhaoxiang Zeng ◽

Jiaxuan Feng ◽

Rui Feng ◽

...

Keyword(s):

Aortic Dissection ◽

Endovascular Treatment ◽

False Lumen ◽

Type B ◽

Type B Aortic Dissection ◽

True Lumen ◽

Chronic Type

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The effect of beta-blockers on hemodynamic parameters in patient-specific blood flow simulations of type-B aortic dissection: a virtual study

Scientific Reports ◽

10.1038/s41598-021-95315-w ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Mohammad Amin Abazari ◽

Deniz Rafieianzab ◽

M. Soltani ◽

Mona Alimohammadi

Keyword(s):

Aortic Dissection ◽

Clinical Decision Making ◽

Beta Blockers ◽

False Lumen ◽

Specific Treatment ◽

Left Ventricular ◽

Patient Specific ◽

Type B ◽

Windkessel Model ◽

Computed Tomography Images

AbstractAortic dissection (AD) is one of the fatal and complex conditions. Since there is a lack of a specific treatment guideline for type-B AD, a better understanding of patient-specific hemodynamics and therapy outcomes can potentially control the progression of the disease and aid in the clinical decision-making process. In this work, a patient-specific geometry of type-B AD is reconstructed from computed tomography images, and a numerical simulation using personalised computational fluid dynamics (CFD) with three-element Windkessel model boundary condition at each outlet is implemented. According to the physiological response of beta-blockers to the reduction of left ventricular contractions, three case studies with different heart rates are created. Several hemodynamic features, including time-averaged wall shear stress (TAWSS), highly oscillatory, low magnitude shear (HOLMES), and flow pattern are investigated and compared between each case. Results show that decreasing TAWSS, which is caused by the reduction of the velocity gradient, prevents vessel wall at entry tear from rupture. Additionally, with the increase in HOLMES value at distal false lumen, calcification and plaque formation in the moderate and regular-heart rate cases are successfully controlled. This work demonstrates how CFD methods with non-invasive hemodynamic metrics can be developed to predict the hemodynamic changes before medication or other invasive operations. These consequences can be a powerful framework for clinicians and surgical communities to improve their diagnostic and pre-procedural planning.

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Mid-term outcomes of endovascular treatment for symptomatic chronic mesenteric ischemia

Surgical Techniques Development ◽

10.4081/std.2011.e2 ◽

2011 ◽

Vol 1 (1) ◽

pp. 2 ◽

Cited By ~ 1

Author(s):

Eva Schönefeld ◽

Susanne Szesny ◽

Konstantinos P. Donas ◽

Georgios A. Pitoulias ◽

Giovanni Torsello

Keyword(s):

Endovascular Treatment ◽

Mesenteric Ischemia ◽

Primary Patency ◽

Mesenteric Arteries ◽

Primary Study ◽

Symptom Improvement ◽

Initial Symptom ◽

Secondary Patency ◽

Chronic Mesenteric Ischemia

The authors would present the mid-term outcomes with the use of stent-supported angioplasty in the treatment of symptomatic chronic mesenteric ischemia (CMI). The present study is a retrospective analysis of 36 patients undergoing endovascular treatment of symptomatic CMI, between November 2000 and September 2009. Primary study endpoints were defined as primary patency, periprocedural and midterm mortality and complications, and symptom improvement after intervention. Forty-one mesenteric arteries (77.3% stenotic and 22.7% occluded vessels) were treated in 36 patients with 42 stents. In 30 patients (83.3%) one visceral artery and in 6 cases (16.7%) two visceral arteries were treated. Overall mortality was 16.7% (n=6) after a 60-month follow-up (mean follow-up period 30.1 months). Two early (<30-day) deaths were caused by visceral ischemia (n=2: 5.5%). Late death was procedure-related in one patient with re-occlusion of the superior mesenteric artery after 12 months. The other 3 patients died from non procedure-related causes; e.g. twice myocardial infarction. Initial symptom relief was observed in 29 patients (80.5%); 7 patients reported no change. Primary patency was 83.3% after 5 years and secondary patency was 90.5% (38 out of 42 stents) among all patients. Two conversions to open surgery were documented. First-line endovascular approach of CMI is a reasonable strategy. Close follow-up is mandatory due to symptom recurrence and restenosis.

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