scholarly journals An Alternative Technique for Ascending and Arcus Aorta Repair in Case of Vascular Diameter Mismatch

2020 ◽  
Vol 23 (2) ◽  
pp. E255-E257
Author(s):  
Bulend Ketenci ◽  
Tamer Kehlibar ◽  
Abdulkerim Özhan ◽  
Mehmet Yilmaz ◽  
Erhan Guler ◽  
...  
Keyword(s):  
Aortic Arch ◽  
Vascular Graft ◽  
Intramural Hematoma ◽  
Type A ◽  
Alternative Technique ◽  
Modified Technique ◽  
Descending Aorta ◽  
Surgical Options ◽  
Aortic Arch Repair ◽  
Intimal Tear

Complicated Type A intramural hematoma involving the arcus aorta requires emergency correction of the aortic arch. Surgical options include reimplantation of the brachiocephalic vessels as an island to a vascular graft, debranching aortic arch surgery, and Kazui technique. This report describes a modified technique for aortic arch repair in a patient with vascular diameter mismatch between the ascending and descending aorta, as well as an intimal tear between the brachiocephalic vessels.

Thoracic Endovascular Aortic Repair for Retrograde Type A Intramural Hematoma With Intimal Disruption in the Descending Aorta

2021 ◽  
pp. 152660282110612
Author(s):  
Yingliang Wang ◽  
Songlin Song ◽  
Chen Zhou ◽  
Wenying Zhu ◽  
Jiacheng Liu ◽  
...  
Keyword(s):  
Adverse Events ◽  
Intramural Hematoma ◽  
Type A ◽  
Ascending Aorta ◽  
Thoracic Endovascular Aortic Repair ◽  
Endovascular Aortic Repair ◽  
Descending Aorta ◽  
Aortic Repair ◽  
Intimal Tear

Purpose: To evaluate the safety and efficacy of thoracic endovascular aortic repair (TEVAR) for retrograde type A intramural hematoma (IMH) with intimal disruption in the descending aorta and report our endovascular therapeutic experience. Materials and Methods: From January 2014 to October 2020, a total of 24 consecutive patients with retrograde type A IMH with intimal disruption (intimal tear or ulcer-like projection) in the descending aorta underwent TEVAR. The demographics, clinical characteristics, treatment details, imaging information, and follow-up results were reviewed. Results: Among all patients with retrograde type A IMH, 13 (54.2%) patients presented with ulcer-like projection and 11 (45.8%) with intimal tear (aortic dissection) in the descending aorta. Successful TEVAR was achieved in all patients. There was no 30-day mortality. During a mean follow-up of 37.5 months, 1 patient (4.2%) developed permanent paralysis, 1 patient (4.2%) underwent reintervention due to the expansion of the aorta distal to the stent resulting from the enlargement of distal intimal tear at the 2 month follow up, and no other adverse events were observed. The latest computed tomographic angiography images showed that the maximum diameter of the ascending aorta and descending aorta significantly decreased after TEVAR (both p<0.001), and the IMH/false lumen in the ascending aorta and the descending thoracic aorta were completely absorbed. Conclusion: Thoracic endovascular aortic repair for selected patients with retrograde type A intramural hematoma that presented with intimal disruption in the descending aorta is feasible and efficient, but close surveillance is needed to manage aortic-related adverse events.

scholarly journals GROWTH AND RE-INTERVENTION OF RESIDUAL AORTIC ARCH AND DESCENDING AORTA AFTER TYPE A DISSECTION REPAIR

2019 ◽  
Vol 73 (9) ◽  
pp. 2124
Author(s):  
Domenico Calcaterra ◽  
Truls Myrmel ◽  
Alan Braverman ◽  
Takeyoshi Ota ◽  
Reed Pyeritz ◽  
...  
Keyword(s):  
Aortic Arch ◽  
Type A ◽  
Descending Aorta ◽  
Type A Dissection

scholarly journals Antegrade transapical branch deployment for endovascular aortic-arch repair by in situ fenestration

2019 ◽  
Author(s):  
Takashi Murakami ◽  
Noriaki Kishimoto ◽  
Etsuji Sohgawa ◽  
Toshihiko Shibata
Keyword(s):  
Aortic Arch ◽  
Carotid Arteries ◽  
Stent Grafts ◽  
Descending Aorta ◽  
Bilateral Carotid ◽  
Aortic Arch Repair ◽  
Sheath Insertion ◽  
Arch Aneurysm ◽  
Transapical Access

Abstract A 76-year-old man presented with an aortic arch aneurysm and was considered a candidate for endovascular aortic arch repair by in situ fenestration. Alternative access routes were explored because of atherosclerotic disease of the descending aorta and bilateral carotid arteries. Transapical deployment of both an aortic and a branched stent grafts was successfully conducted without cerebral complications. The transapical access might have the potential to reduce the risks of complications related to large bore-sheath insertion to the carotid arteries.

scholarly journals Sedatives during circulatory arrest are not necessary for aortic arch repair in acute type A aortic dissection

2020 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Alexander O. Makkinejad ◽  
Jeffrey Clemence ◽  
Elizabeth L. Norton ◽  
Linda Farhat ◽  
Xiao-Ting Wu ◽  
...  
Keyword(s):  
Aortic Dissection ◽  
Aortic Arch ◽  
Circulatory Arrest ◽  
Type A ◽  
Acute Type ◽  
Type A Aortic Dissection ◽  
Aortic Arch Repair

scholarly journals Detection of the intimal tear in aortic dissection and ulcer-like projection in intramural hematoma: usefulness of full-phase retrospective ECG-gated CT angiography

2020 ◽  
Vol 38 (11) ◽  
pp. 1036-1045
Author(s):  
Satoru Yanagaki ◽  
Takuya Ueda ◽  
Atsuro Masuda ◽  
Hideki Ota ◽  
Yuta Onaka ◽  
...  
Keyword(s):  
Retrospective Study ◽  
Aortic Dissection ◽  
Ct Angiography ◽  
Intramural Hematoma ◽  
Ascending Aorta ◽  
Single Center ◽  
Descending Aorta ◽  
Diastolic Phase ◽  
Electrocardiogram Ecg ◽  
Intimal Tear

Abstract Purpose To compare the accuracy of non-electrocardiogram (ECG)-gated CT angiography (CTA), single-diastolic-phase ECG-gated CTA, and full-phase ECG-gated CTA in detecting the intimal tear (IT) in aortic dissection (AD) and ulcer-like projection (ULP) in intramural hematoma (IMH). Materials and methods A total of 81 consecutive patients with AD and IMH of the thoracic aorta were included in this single-center retrospective study. Non-ECG-gated CTA, single-diastolic-phase ECG-gated CTA, and full-phase ECG-gated CTA were used to detect the presence of the IT and ULP in thoracic aortic regions including the ascending aorta, aortic arch, and proximal and distal descending aorta. Results The accuracy of detecting the IT and ULP was significantly greater using full-phase ECG-gated CTA (88% [95% CI: 100%, 75%]) than non-ECG-gated CTA (72% [95% CI: 90%, 54%], P = 0.001) and single-diastolic-phase ECG-gated CTA (76% [95% CI: 93%, 60%], P = 0.008). Conclusion Full-phase ECG-gated CTA is more accurate in detecting the IT in AD and ULP in IMH, than non-ECG-gated CTA and single-diastolic-phase ECG-gated CTA.

scholarly journals One-stage aortic replacement for type A aortic dissection: using a Vasoring and a conventional elephant trunk graft

2019 ◽  
Vol 56 (1) ◽  
pp. 189-196
Author(s):  
Jeng Wei ◽  
Yung-Tsai Lee ◽  
Ching-Wen Wu
Keyword(s):  
Aortic Dissection ◽  
Aortic Arch ◽  
Vascular Graft ◽  
Open Surgery ◽  
Vascular Ring ◽  
False Lumen ◽  
Type A ◽  
Elephant Trunk ◽  
Type A Aortic Dissection ◽  
Aortic Replacement

AbstractOBJECTIVESWe used a vascular ring connector (Vasoring) and a conventional elephant trunk graft for complete repair in open surgery for type A aortic dissection. This report described the immediate and mid-term results of this new technique.METHODSWe used a rigid titanic ring as a stent in the vascular graft for rapid sutureless anastomosis in the reconstruction of type A aortic dissection.RESULTSA total of 65 consecutive patients with Stanford type A aortic dissection underwent open surgery performed by a single surgeon from November 2007 to February 2017. All patients underwent aortic reconstruction with vascular grafts and Vasorings (21 patients in the ascending aorta and 44 patients in the total aortic arch). For total aortic arch replacement, we implanted the conventional vascular graft in the proximal descending thoracic aorta as an elephant trunk graft. Concomitant procedures included the Bentall procedure (9 patients), the David operation (6 patients), coronary artery bypass grafting (9 patients), heart transplantation (1 patient), mitral valve replacement (2 patients) and endovascular aortic repair (1 patient). The mean duration of postoperative endotracheal intubation was 17.0 ± 11.8 h. The average blood loss was 520 ± 743 ml, and 25% of patients required no blood transfusion. The in-hospital mortality rate was 6%.CONCLUSIONSThe combined use of the vascular ring connector and the conventional elephant trunk graft may reduce bleeding and pump time, stop the blood flow in the false lumen and allow the 1-stage total arch replacement to be performed safely. The conventional elephant trunk graft is free from stent graft-induced new entry.

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