scholarly journals Early Results of the PETTICOAT Technique for the Management of Acute Type A Aortic Dissection

Aorta ◽  
2017 ◽  
Vol 05 (04) ◽  
pp. 124-128 ◽  
Author(s):  
Vamshi Krishna Kotha ◽  
Zlatko Pozeg ◽  
Eric Herget ◽  
Michael Moon ◽  
Jehangir Appoo ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Ischemia ◽  
False Lumen ◽  
Bare Metal Stents ◽  
Metal Stents ◽  
Acute Type ◽  
Bare Metal ◽  
True Lumen ◽  
Descending Aorta ◽  
Type A Aortic Dissection

AbstractConventional surgical techniques for acute Type A aortic dissection (ATAAD) generally fail to address residual dissection in the descending aorta. The persistence of a false lumen is associated with visceral malperfusion in the acute setting and adverse aortic remodeling in the chronic setting. Hybrid aortic arch repair techniques may improve perioperative and long-term mortality by expanding the true lumen and obliterating the false lumen. However, there is a limit to the extent of aortic coverage due to the concomitant risk of spinal cord ischemia. In Type B dissection, the PETTICOAT (Provisional Extension To Induce Complete Attachment) technique, which entails stent graft coverage of the primary intimal tear followed by bare metal stent placement distally, may improve true lumen caliber and promote false lumen thrombosis without increasing the risk of spinal cord ischemia, as intercostal branches remain perfused through the bare metal stents. The technique of hybrid arch with surgical creation of a Dacron landing zone covering a stent graft in the proximal descending aorta and bare metal stents in the thoraco-abdominal aorta is a promising concept in the treatment of ATAAD.

Spinal Cord Ischemia in the Setting of Acute Type B Aortic Dissection: Successful Rescue with Thoracic Endovascular Aortic Repair

2021 ◽  
pp. 153857442110451
Author(s):  
Masaki Kano ◽  
Toru Iwahashi ◽  
Toshiya Nishibe ◽  
Kentaro Kamiya ◽  
Hitoshi Ogino
Keyword(s):  
Spinal Cord ◽  
Aortic Dissection ◽  
Medical Management ◽  
Spinal Cord Ischemia ◽  
False Lumen ◽  
Thoracic Endovascular Aortic Repair ◽  
Endovascular Aortic Repair ◽  
Acute Type ◽  
Type B ◽  
Type B Aortic Dissection

We report 2 cases of successful thoracic endovascular aortic repair (TEVAR) for acute type B aortic dissection (ABAD) complicated with spinal cord ischemia (SCI). Case 1. A 70-year-old gentleman found with an uncomplicated ABAD with false lumen occluded, developed SCI shortly after admission during the initial medical management. Cerebrospinal fluid drainage (CSFD) was initiated followed by emergent TEVAR. SCI improved, and the patient was discharged. Case 2. A 52-year-old gentleman developed uncomplicated ABAD with patent false lumen. 5 hours after admission, he developed SCI during the initial medical management. Emergent TEVAR was performed followed by CSFD, and the SCI improved before discharge. These cases prompted us to address prompt TEVAR for primary entry closure and true lumen dilatation with postoperative hypertensive management to relieve the dynamic obstruction of the segmental arteries responsible for the compromised spinal cord circulation in complicated ABAD.

scholarly journals Treatment of Acute Stanford Type B Aortic Dissection With a Novel Cylindrical Balloon Catheter in Dogs

Circulation ◽  
2000 ◽  
Vol 102 (suppl_3) ◽  
Author(s):  
Hiromu Terai ◽  
Nobushige Tamura ◽  
Tatsuo Nakamura ◽  
Kazunobu Nishimura ◽  
Norimasa Tsutsui ◽  
...  
Keyword(s):  
Blood Flow ◽  
Aortic Dissection ◽  
Balloon Catheter ◽  
False Lumen ◽  
Aortic Blood Flow ◽  
Acute Type ◽  
Type B ◽  
Type B Aortic Dissection ◽  
True Lumen ◽  
Descending Aorta

Background —Despite recent progress in medical and surgical treatment, acute type B aortic dissection still carries a high mortality rate. We have developed a novel cylindrical balloon catheter for less invasive treatment to block the entry of the dissection and induce thrombotic occlusion of the false lumen. The balloon has the shape of a sheet when deflated but a double-cylinder shape when inflated. Therefore, aortic blood flow is maintained through the cylindrical lumen during balloon inflation. Methods and Results —Six beagle dogs underwent a left thoracotomy at the 6th intercostal space. An acute dissection of 4-cm length was created surgically on the descending aorta. The balloon catheter was inserted through the distal descending aorta and advanced to the entry site. The balloon catheter was inflated for 6 hours. The blood flow in the descending aorta and the position of the balloon was monitored by color Doppler echovasculography. Four dogs were killed humanely on the following day and 2 dogs 10 days after the surgery. The descending aorta was examined macroscopically and microscopically in all dogs. In all dogs, the false lumen was occluded by thrombi. Although no dog had clinical evidence of distal thromboembolism, 2 of the 4 dogs that were killed on the second postoperative day had fresh mural thrombi in the true lumen. Conclusions —The false lumen of the acute type B aortic dissection was effectively occluded by the novel cylindrical balloon catheter in the canine experimental model. The thrombus formation in the true lumen is the problem to be solved.

scholarly journals Endovascular fenestration of aortic dissection membrane after failed frozen elephant trunk procedure

2019 ◽  
Author(s):  
Jan Raupach ◽  
Vendelin Chovanec ◽  
Veronika Kozakova ◽  
Jan Vojacek
Keyword(s):  
Aortic Dissection ◽  
False Lumen ◽  
Acute Type ◽  
Frozen Elephant Trunk ◽  
True Lumen ◽  
Elephant Trunk ◽  
Type A Aortic Dissection ◽  
Elephant Trunk Technique ◽  
Elephant Trunk Procedure ◽  
Frozen Elephant Trunk Technique

Abstract We report a case of a 51-year-old male with complicated acute type A aortic dissection who initially underwent a supracoronary and aortic arch replacement using frozen elephant trunk technique. False-lumen perfusion was revealed later which resulted in the collapse of the true lumen. Endovascular fenestration of the dissection flap was performed. True-lumen reperfusion with false-lumen regression was achieved. Endovascular fenestration using a re-entry catheter represents an efficient and safe treatment approach for this rare but serious complication.

Computed tomography angiography findings predict the risk factors for preoperative acute ischaemic stroke in patients with acute type A aortic dissection

2020 ◽  
Vol 57 (5) ◽  
pp. 912-919 ◽  
Author(s):  
Hongliang Zhao ◽  
Wanling Ma ◽  
Didi Wen ◽  
Weixun Duan ◽  
Minwen Zheng
Keyword(s):  
Risk Factors ◽  
Computed Tomography ◽  
Aortic Valve ◽  
False Lumen ◽  
Ascending Aorta ◽  
Acute Type ◽  
Aortic Valve Insufficiency ◽  
True Lumen ◽  
Type A Aortic Dissection ◽  
Valve Insufficiency

Abstract OBJECTIVES Acute ischaemic stroke (AIS) is a highly dreaded complication of acute type A aortic dissection (ATAAD). Knowledge about independent predictors of preoperative AIS in patients with ATAAD remains unclear. The aim of this study was to identify the risk factors for preoperative AIS in patients with ATAAD by computed tomography angiography (CTA) findings. METHODS Between October 2014 and March 2017, 281 (217 male; mean age, 50 years) patients with ATAAD underwent aortic CTA and diffusion-weighted magnetic resonance imaging of the brain was used to confirm the results. The clinical data and CTA findings were evaluated retrospectively. Patients were divided into 2 groups depending on the presence or absence of preoperative AIS. RESULTS Preoperative AIS was detected in 103 (36.7%) of the patients with ATAAD. Univariable analysis of the clinical characteristics and CTA findings revealed that age, aortic valve insufficiency (moderate or severe), the ratio of the diameter of the true lumen of the ascending aorta to the diameter of the involved ascending aorta, intimal flap plaque, dissection of the common carotid artery (CCA), the lower density of the unilateral internal carotid artery, the CCA originating from the false lumen and dissection of the subclavian artery were implicated in patients with ATAAD with AIS. Multivariable analysis further showed that aortic valve insufficiency (moderate or severe) [odds ratio (OR) 2.033, 95% confidence interval (CI) 1.052–3.931; P = 0.035], 2 CTA findings including the ratio of the diameters (OR 0.074, 95% CI 0.011–0.516; P = 0.009) and dissection of the CCA (OR 2.422, 95% CI 1.389–4.224; P = 0.002) were independent risk predictors for preoperative AIS in patients with ATAAD. The lower density in the false lumen, the same enhancement in the true and false lumen with re-entry and the stenosis of the true lumen without re-entry significantly increased the risk of preoperative AIS in CCA dissection. CONCLUSIONS Aortic valve insufficiency (moderate or severe), the ratio of the diameters of the true and false lumens and CCA dissection are independent predictors of preoperative AIS in patients with ATAAD. The specific carotid and aortic CTA findings may help to predict the risk factors for preoperative AIS in patients with ATAAD. Clinical registration number 20120216-4.

Direct true lumen cannulation for type A aortic dissection (Samurai technique) in emergency scenarios

2021 ◽  
Keyword(s):  
Cardiopulmonary Bypass ◽  
Aortic Dissection ◽  
False Lumen ◽  
Arterial Occlusion ◽  
Type A ◽  
Acute Type ◽  
Arterial Cannulation ◽  
True Lumen ◽  
Type A Aortic Dissection ◽  
Cannulation Site

Choosing the optimal arterial cannulation site in type A aortic dissection may be challenging. Aortic dissection is a dynamic condition that can change at any time. Thus all the alternatives available should be known by surgeons in order to adapt to the possible problems that may arise. In this video tutorial, we present a patient with acute type A aortic dissection who, after cardiopulmonary bypass with axillary arterial cannulation, developed a major complication: intraoperative malperfusion due to pressurization of the false lumen. The patient developed occlusion of the right coronary artery with electrocardiogram changes, inferior akinesia, and ventricular arrhythmias. Cerebral saturation was also significantly decreased. This scenario of acute malperfusion calls for immediate action. We proceeded to switch the cardiopulmonary bypass configuration from axillary to direct true lumen cannulation. This technique, also known as the Samurai technique, is feasible in most cases and advantageous in this emergency situation, allowing prompt reestablishment of adequate perfusion of the true lumen . Some authors even advocate more widespread use of this technique because it may ensure antegrade perfusion while avoiding progression of the dissection flap and reduce the rate of the most common complications of other cannulation sites such as plexus injury during axillary cannulation or cerebral embolization through mobilization of thrombi or calcification from femoral retrograde perfusion. This technique is useful in cases of circumferential dissection and in patients with relative contraindications for peripheral cannulation such as morbid obesity or peripheral arterial occlusion by atherosclerosis or by the dissection itself.

Repair of acute type A dissection with distal malperfusion using a novel hybrid arch device

2020 ◽  
Keyword(s):  
Aortic Dissection ◽  
Aortic Arch ◽  
Circulatory Arrest ◽  
Spinal Cord Ischemia ◽  
False Lumen ◽  
Type A ◽  
Acute Type ◽  
Type A Aortic Dissection ◽  
Acute Type A Dissection ◽  
Feasible Option

Acute type A aortic dissection remains a high-risk surgical condition, and mortality among those presenting with malperfusion is up to 3-fold higher. Despite the added technical challenge of distal aortic arch interventions in the acute setting, it may be necessary to resolve distal malperfusion in patients with this disorder. The ideal arch intervention to address acute type A aortic dissection complicated by malperfusion should address the following objectives: (1) to relieve distal malperfusion by expanding the distal true lumen and depressurizing the false lumen; (2) to avoid compromising arch branches without requiring additional arch branch interventions; (3) to minimize the risk of spinal cord ischemia; and (4) to minimize the operative duration and circulatory arrest time. The use of an uncovered aortic arch stent that is delivered in an antegrade manner during circulatory arrest, concomitantly with hemiarch replacement, therefore represents an attractive solution in the management of acute type A aortic dissection complicated by malperfusion. This strategy does not require complex arch reconstruction and may thus be a feasible option among cardiac and vascular surgeons in lower volume aortic centers. Here we present a step-by-step approach to acute type A aortic dissection repair with hemiarch repair and delivery of an uncovered arch stent for a patient presenting with malperfusion.

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