Echo-Guided Seldinger Technique Facilitates Ascending Aorta Cannulation in Type A Aortic Dissection

<p>Management of acute Stanford type A aortic dissection remains a major surgical challenge. Directly cannulating the ascending aorta provides a rapid establishment of cardiopulmonary bypass but consists of risks such as complete rupture of the aorta, false lumen cannulation, subsequent malperfusion and propagation of the dissection.</p><p>We describe a technique of cannulating the ascending aorta in patients with acute aortic dissection that can be performed rapidly in hemodynamically unstable patients under ultrasound-epiaortic and transesophageal (TEE) guidance.</p>

Download Full-text

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

Journal of Endovascular Therapy ◽

10.1177/1526602816680089 ◽

2016 ◽

Vol 24 (1) ◽

pp. 75-80 ◽

Cited By ~ 17

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.

Download Full-text

Epiaortic Ultrasound-Guided True Lumen Cannulation of Ascending Aorta in Acute Aortic Dissection Type A

Journal of the Medical Association of Thailand ◽

10.35755/jmedassocthai.2021.04.11895 ◽

2021 ◽

Vol 104 (4) ◽

pp. 604-609

Keyword(s):

Aortic Dissection ◽

Acute Aortic Dissection ◽

Axillary Artery ◽

Type A ◽

Ascending Aorta ◽

Ultrasound Guided ◽

True Lumen ◽

Artery Cannulation ◽

Aortic Cannulation ◽

Aortic Dissection Type A

Background: The choice of arterial inflow for acute Stanford type A aortic dissection repair remains controversial. The axillary artery should be considered as first choice for cannulation, but this technique is time-consuming. The ascending aortic cannulation provides antegrade perfusion and can be performed rapidly but there are several concerns such as aortic rupture, extension of dissection, and false lumen cannulation. Objective: To compare the establishment time of cardiopulmonary bypass (CPB) and postoperative outcomes of the two cannulation techniques that provide antegrade perfusion, which was direct true lumen cannulation on the dissected ascending aorta using epiaortic ultrasound-guided and axillary artery cannulation in Siriraj Hospital. Materials and Methods: The authors retrospectively reviewed all the 30 cases of acute aortic dissection type A using two different cannulation methods performed between February 2011 and May 2017. Direct true lumen ascending aortic cannulation was performed using the epiaortic ultrasound-guide with Seldinger technique in 12 patients, and axillary artery cannulation was performed in 18 patients. Results: The direct true lumen ascending aortic cannulation was safely performed in all patients. None of them had aortic rupture. Skin incision to CPB time was significantly faster in the epiaortic ultrasound-guided ascending aortic cannulation group at 29±8 versus 49±14 minutes (p<0.001). The 30-day mortality and postoperative adverse events, such as ischemic stroke, acute kidney injury, visceral organ and limb malperfusion showed no statistically significant difference from the axillary artery cannulation method. Conclusion: Epiaortic ultrasound-guided true lumen cannulation of ascending aorta in the treatment of acute aortic dissection type A is safe and feasible. Skin incision to CPB time can be performed faster and provided good outcome compared to the axillary artery cannulation technique. Keywords: Acute aortic dissection, Ascending cannulation, Epiaortic ultrasound

Download Full-text

Acute Type A Aortic Dissection After TAVR in an Octogenarian With Ascending Aorta Aneurysm

JACC Cardiovascular Interventions ◽

10.1016/j.jcin.2021.10.021 ◽

2021 ◽

Author(s):

Helen Hashemi ◽

Sahil Khera ◽

Malcolm Anastasius ◽

Ismail El-Hamamsy ◽

Gilbert H.L. Tang ◽

...

Keyword(s):

Aortic Dissection ◽

Type A ◽

Ascending Aorta ◽

Acute Type ◽

Type A Aortic Dissection ◽

Aorta Aneurysm

Download Full-text

Outcomes of patients who declined surgery for acute Stanford type A aortic dissection with patent false lumen of the ascending aorta†

Interactive Cardiovascular and Thoracic Surgery ◽

10.1093/icvts/ivw451 ◽

2017 ◽

Vol 25 (1) ◽

pp. 47-51 ◽

Cited By ~ 4

Author(s):

Tadashi Kitamura ◽

Shinzo Torii ◽

Tetsuya Horai ◽

Koichi Sughimoto ◽

Yusuke Irisawa ◽

...

Keyword(s):

Aortic Dissection ◽

False Lumen ◽

Type A ◽

Ascending Aorta ◽

Type A Aortic Dissection ◽

Patent False Lumen

Download Full-text

Equations Estimating the Predissected Diameter of the Ascending Aorta for Acute Type A Aortic Dissection

The Annals of Thoracic Surgery ◽

10.1016/j.athoracsur.2019.02.046 ◽

2019 ◽

Vol 108 (2) ◽

pp. 481-490 ◽

Cited By ~ 1

Author(s):

Takashi Yamauchi ◽

Hiroshi Takano ◽

Toshiki Takahashi ◽

Takafumi Masai ◽

Masayuki Sakaki ◽

...

Keyword(s):

Aortic Dissection ◽

Type A ◽

Ascending Aorta ◽

Acute Type ◽

Type A Aortic Dissection

Download Full-text

Early misdiagnosis of acute aortic dissection: A case report and analysis of the causes

International Journal of Diagnostic Imaging ◽

10.5430/ijdi.v4n1p15 ◽

2016 ◽

Vol 4 (1) ◽

pp. 15

Author(s):

Xiao-yan Chen ◽

Fan-liang Kong ◽

Tong-guo Wu

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Case Report ◽

Aortic Dissection ◽

Emergency Room ◽

Male Patient ◽

Acute Aortic Dissection ◽

Type A ◽

Ascending Aorta ◽

Type A Aortic Dissection

Type A aortic dissection is a catastrophic clinical entity involving the ascending aorta. In this case report, a patient was admitted to the emergency room with a presentation resembling acute myocardial infarction (AMI) that led to the inappropriate administration of anticoagulant agents or platelet. This is a case report of a 69-year-old male patient with early misdiagnosis and analysis of type A aortic dissection with discussion on the causes of misdiagnosis in light of the literature.

Download Full-text

Type A aortic dissection in aneurysms having modelled pre-dissection maximum diameter below 45 mm: should we implement current guidelines to improve the survival benefit of prophylactic surgery?

European Journal of Cardio-Thoracic Surgery ◽

10.1093/ejcts/ezaa351 ◽

2020 ◽

Cited By ~ 3

Author(s):

Piergiorgio Tozzi ◽

Ziyad Gunga ◽

Lars Niclauss ◽

Dominique Delay ◽

Aurelian Roumy ◽

...

Keyword(s):

Aortic Dissection ◽

Survival Benefit ◽

Type A ◽

Ascending Aorta ◽

Aortic Diameter ◽

Maximum Diameter ◽

Type A Aortic Dissection ◽

Aorta Replacement ◽

Current Guidelines ◽

Ascending Aorta Replacement

Abstract OBJECTIVES Current guidelines recommend prophylactic replacement of the ascending aorta at an aneurysmal diameter of >55 mm to prevent acute Type A aortic dissection (TAAD) in non-Marfan patients. Several publications have challenged this threshold, suggesting that surgery should be performed in smaller aneurysms to prevent this devastating disease. We reviewed our experience with measuring aortic size at the time of TAAD to validate the existing recommendation for prophylactic ascending aorta replacement. METHODS All patients who had been admitted for TAAD to our emergency department from 2014 to 2019 and underwent ascending aorta replacement were included. Marfan patients were excluded. The maximum diameter of the dissected aorta was measured preoperatively using CT scan. We estimated the aortic diameter at the time of dissection to be 7 mm smaller than the measured maximum diameter of the dissected aorta (modelled pre-dissection diameter). RESULTS Overall, 102 patients were included. Of these, 67 were male (65.6%) and 35 were female (34.4%), and the cohort’s mean age was 65 ± 12.1 years. In addition, 66% were treated for arterial hypertension. The mean maximum modelled pre-dissection diameter was 39.6 ± 4.8 mm: 39.1 ± 5.1 mm in men and 40.7 ± 2.8 mm in women (P = 0.1). The cumulative 30-day mortality rate was 19.6% (20/102). CONCLUSIONS TAAD occurred at a modelled aortic diameter below 45 mm in 87.7% of our patients. Therefore, the current aortic diameter threshold of 55 mm excludes ∼99% of patients with TAAD from prophylactic replacement of the ascending aorta. The maximum diameter of the ascending aorta warrants reappraisal and this parameter should be a distinct part of a personalized decision-making process that also takes into account age, gender and body surface area to establish the surgical indication for preventive aorta replacement aimed to improve the survival benefit of this procedure.

Download Full-text