scholarly journals Percutaneous endovascular repair of acute type A intramural hematoma of the ascending aorta

2019 ◽  
Vol 8 (5) ◽  
pp. 585-586 ◽  
Author(s):  
Ali Khoynezhad
Keyword(s):  
Endovascular Repair ◽  
Intramural Hematoma ◽  
Type A ◽  
Ascending Aorta ◽  
Acute Type

Risk stratification on admission for predicting death or need for surgery in patients with acute type A intramural hematoma receiving medical therapy – validation cohort

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
S Kageyama
Keyword(s):  
Risk Score ◽  
Primary Endpoint ◽  
Validation Cohort ◽  
Intramural Hematoma ◽  
Type A ◽  
Cardiovascular Death ◽  
Ascending Aorta ◽  
Acute Type ◽  
Derivation Cohort ◽  
Aorta Diameter

Abstract Background There has been continuing discussion regarding the treatment strategy for acute type A intramural hematoma (IMH). We previously examined the risk factors of death or need for surgery for acute type A IMH in patients receiving medical treatment using clinical findings on hospital arrival and developed a simple risk score using the factors. Purpose We examined the accuracy of the risk score in the validation cohort. Methods From 2009 to 2014, 57 consecutive patients diagnosed with acute type A IMH who were receiving initial medical treatment were retrospectively included for derivation cohort. Primary endpoint was a composite of cardiovascular death and operation within 1 year after onset. On admission, the primary endpoint could be predicted with 89.7% sensitivity and 75% specificity if the patient had ulcer-like projection (ULP) and/or ≥2 of the following factors: systolic blood pressure (SBP) <120 mmHg, ascending aorta diameter>45 mm, and pericardial effusion (PE). In the current study, validation cohort study was performed from 2015 to 2020 in 73 consecutive patients who met the same inclusion criteria for derivation cohort to evaluate the risk factors and the accuracy of the risk score. Result Mean age of onset was 74 years old. Mean SBP on arrival was 134 mmHg. Computed tomography (CT) on arrival showed a mean ascending aorta diameter of 46 mm. ULP and PE were seen in 27% and 41% of cases, respectively. Thirty-three patients (45.2%) reached the primary endpoint (cardiovascular death, 8 cases [11%]; operation, 25 cases [34.2%]). In univariate analysis of admission values, the primary endpoint group had significantly lower SBP (116±29 vs 147±35 mmHg), higher ascending aorta diameter (49±8 vs 45±9 mm), and higher frequency of ULP (50% vs 10%) and PE (56% vs 29%) than did the event-free group. Multivariate analysis showed that ULP and SBP were significant predictors of the primary endpoint. The total risk score ≥2 could predict the primary endpoint with 87.5% sensitivity and 71.7% specificity (area under the receiver operating characteristic curve, 0.791). Conclusion The risk score was useful to predict cardiovascular death and the need for surgery in patients with acute type A IMH receiving medical therapy in the validation cohort study. ROC curve for the risk score Funding Acknowledgement Type of funding source: None

Initial medical management in acute type A aortic dissection patients with a thrombosed false lumen in the ascending aorta combining intramural hematoma and retrograde dissection from the descending to the ascending aorta

2018 ◽  
Vol 9 (3_suppl) ◽  
pp. S13-S20 ◽  
Author(s):  
Kenji Sadamatsu ◽  
Susumu Takase ◽  
Shuichiro Sagara ◽  
Kensuke Ohe ◽  
Jun-ichiro Nishi ◽  
...  
Keyword(s):  
Aortic Dissection ◽  
Medical Management ◽  
False Lumen ◽  
Intramural Hematoma ◽  
Type A ◽  
Daily Practice ◽  
Ascending Aorta ◽  
Maximum Diameter ◽  
Acute Type ◽  
Type A Aortic Dissection

Background: The feasibility of medical management for select patients with acute type A aortic dissection has been reported from a few institutions. In this study, we retrospectively investigated the safety and feasibility of our conservative approach for patients with type A aortic dissection in daily practice. Methods: From January 2013 to December 2017, 131 consecutive patients were admitted to our institution for acute aortic dissection, including 58 patients of type A. Initial medical management was attempted in select patients who were clinically stable and had a thrombosed false lumen of the ascending aorta without ulcer-like projections in the ascending aorta. Results: Except for nine patients contraindicated for surgery, urgent surgery was performed in 26 patients (SRG group), while 23 patients (MED group) were treated with the initial medical management. The maximum diameter of the ascending aorta was significantly larger in the SRG group than in the MED group. In the MED group, the heart rate and blood pressures were well-controlled at admission to the intensive-care unit, and the systolic blood pressure was further reduced at 24 h after. The in-hospital mortality rates of the MED and SRG groups were 0% and 15%, respectively. During the follow-up period, the survival rate was significantly higher in the MED group than in the SRG group, and the aortic event-free survival at one year was 80%. Conclusions: The initial medical management for select patients with a thrombosed false lumen in the ascending aorta was a safe and feasible strategy in real-world practice.

Acute retrograde type A intramural hematoma treated with an endovascular approach

2018 ◽  
Vol 26 (4) ◽  
pp. 308-310 ◽  
Author(s):  
Anh T Vo ◽  
Khoi M Le ◽  
Trang T Nguyen ◽  
Thanh T Vu ◽  
Thien T Vu ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Intramural Hematoma ◽  
Type A ◽  
Sudden Onset ◽  
Ascending Aorta ◽  
Acute Type ◽  
Descending Aorta ◽  
Severe Chest Pain ◽  
Endovascular Approach

A 71-year-old woman was admitted with sudden onset of severe chest pain. Computed tomography demonstrated acute type A intramural hematoma with an entry tear in the first part of the descending aorta. The patient refused an operation. Endovascular repair was performed to prevent conversion to a typical dissection of the ascending aorta. At the 1-year follow-up, computed tomography showed total resolution of the intramural hematoma.

Type a Aortic Dissection Developing during Endovascular Repair of an Acute Type B Dissection

2003 ◽  
Vol 10 (2) ◽  
pp. 254-259 ◽  
Author(s):  
Fabrizio Fanelli ◽  
Filippo Maria Salvatori ◽  
Giulia Marcelli ◽  
Mario Bezzi ◽  
Marco Totaro ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Endovascular Repair ◽  
Type A ◽  
Carotid Artery Dissection ◽  
Ascending Aorta ◽  
Artery Dissection ◽  
Acute Type ◽  
Type B ◽  
Left Carotid Artery ◽  
Type B Dissection

Purpose: To describe an extension of type B dissection into type A during endoluminal treatment of acute type B dissection. Case Report: A 57-year-old man with acute type B dissection underwent endovascular repair using 2 Excluder stent-grafts. Before releasing the second stent-graft, the patient complained of mild central chest pain, headache, and visual flashes, but no hemodynamic changes were noticed. An angiogram, performed soon afterwards, showed a retrograde extension of the dissection through the aortic arch involving both the left carotid artery and the ascending aorta. The procedure was completed, and the patient was transported to the operating room where the proximal ascending aorta was replaced. Spiral computed tomographic angiography performed 2 weeks after the procedure showed complete exclusion of the primary entry tear. At 6-month follow-up, the patient was asymptomatic; the left carotid artery dissection had disappeared. Conclusions: Endovascular repair of acute type B dissection is technically feasible, but longer experience will help prevent technical complications.

scholarly journals The first endovascular repair of an acute type A dissection using an endograft designed for the ascending aorta

2012 ◽  
Vol 55 (1) ◽  
pp. 220-222 ◽  
Author(s):  
Matthew J. Metcalfe ◽  
Alan Karthikesalingam ◽  
Steve A. Black ◽  
Ian M. Loftus ◽  
Robert Morgan ◽  
...  
Keyword(s):  
Endovascular Repair ◽  
Type A ◽  
Ascending Aorta ◽  
Acute Type ◽  
Acute Type A Dissection ◽  
Type A Dissection

scholarly journals Pseudoaneurysm as a Late Complication of Chronic Stanford Type A Intramural Hematoma Requiring Endovascular Repair

2020 ◽  
Vol 2 (15) ◽  
pp. 2470-2475
Author(s):  
Wayne H. Miller ◽  
David Hsi ◽  
Anna Koulova ◽  
Andrey Vavrenyuk ◽  
Isaac George ◽  
...  
Keyword(s):  
Endovascular Repair ◽  
Late Complication ◽  
Intramural Hematoma ◽  
Type A

Acute Type A Aortic Dissection Treated Using a Tubular Stent-Graft in the Ascending Aorta and a Multibranched Stent-Graft in the Aortic Arch

2016 ◽  
Vol 24 (1) ◽  
pp. 75-80 ◽  
Author(s):  
Tilo Kölbel ◽  
Christian Detter ◽  
Sebastian W. Carpenter ◽  
Fiona Rohlffs ◽  
Yskert von Kodolitsch ◽  
...  
Keyword(s):  
Aortic Dissection ◽  
Stent Graft ◽  
Open Surgery ◽  
Type A ◽  
Ascending Aorta ◽  
Type I ◽  
Acute Type ◽  
Stent Grafts ◽  
Type A Aortic Dissection ◽  
Custom Made

Purpose: To describe the combined use of a tubular stent-graft for the ascending aorta and an inner-branched arch stent-graft for patients with acute type A aortic dissection. Technique: The technique to deploy these modular, custom-made stent-grafts is demonstrated in 2 patients with acute DeBakey type I aortic dissections and significant comorbidities precluding open surgery. Both emergent procedures were made possible by the availability of suitable devices manufactured for elective repair in other patients. After preliminary carotid-subclavian bypass, a long Lunderquist guidewire was introduced from the right femoral artery to the left ventricle for delivery of the Zenith Ascend and Zenith Branched Arch Endovascular Grafts under inflow occlusion. Bridging stent-grafts were delivered to the innominate and left common carotid arteries to connect to the 2 inner branches; the left subclavian artery was occluded. Both cases were technically successful and resulted in exclusion of the false lumen in the ascending aorta. The operating and fluoroscopy times did not exceed those of comparable elective procedures. The patients were rapidly extubated shortly after the procedure and without serious immediate complications. One patient survived 11 months with a satisfactory repair; the other succumbed to complications of recurrent pneumonia after 23 days. Conclusion: Endovascular treatment of patients with acute type A aortic dissection using a combination of tubular and branched stent-grafts in the ascending aorta is feasible and offers an alternative strategy to open surgery.

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