scholarly journals Surveillance for Moderate-Sized Thoracic Aortic Aneurysms: Equality is the Goal

2021 ◽  
Author(s):  
Metesh Acharya ◽  
Giovanni Mariscalco
Keyword(s):  
Cardiac Surgery ◽  
Recent Article ◽  
Acute Aortic Dissection ◽  
Aortic Surgery ◽  
Aortic Aneurysms ◽  
Fundamental Aspect ◽  
Economic Disparities ◽  
Thoracic Aortic Aneurysms ◽  
Selection For

Comprehensive clinical and imaging-based surveillance represents a fundamental aspect in the management of thoracic aortic aneurysms (TAAs), affording the opportunity to identify intermediate-sized TAAs before the onset of worrying symptoms or devastating acute aortic dissection/rupture. Currently, size-based indices are favoured as the major determinants driving patient selection for surgery, as supported by aortic guidelines, although it is recognised that smaller sub-threshold TAAs may still confer substantial risks. Prophylactic aortic surgery can be offered within set timeframes at dedicated aortic centres with excellent outcomes, to mitigate the threat of acute aortic complications associated with repeatedly deferred intervention. In this commentary, we discuss a recent article from the Journal of Cardiac Surgery which highlights important socio-economic disparities in TAA surveillance and follow-up.

Endovascular abdominal aortic aneurysm repair in patients with Marfan syndrome

Vascular ◽  
2019 ◽  
Vol 28 (1) ◽  
pp. 48-52
Author(s):  
Allan Marc Conway ◽  
Khalil Qato ◽  
Gautam Anand ◽  
Laurie Mondry ◽  
Gary Giangola ◽  
...  
Keyword(s):  
Marfan Syndrome ◽  
Open Repair ◽  
Aortic Surgery ◽  
Endovascular Aneurysm Repair ◽  
Aortic Aneurysms ◽  
Type I ◽  
Femoral Access ◽  
Abdominal Aortic ◽  
Aneurysm Repair

Objectives Marfan syndrome patients are at risk for aortic degeneration. Repair is traditionally performed with open surgery as this is deemed more durable. Endovascular aneurysm repair remains controversial. We report on the outcomes of Marfan syndrome patients with abdominal aortic aneurysms undergoing endovascular aneurysm repair. Methods The Vascular Quality Initiative registry identified 35,889 patients, including 29 with Marfan syndrome, treated with endovascular aneurysm repair from January 2003 to December 2017. Outcomes were analyzed per the Society for Vascular Surgery reporting standards. Results Median age was 70.0 years (IQR, 57.0–75.0), and 22 (75.9%) were male. Median aneurysm diameter was 5.3 cm (IQR, 4.9–6.3 cm), with an aortic neck length and diameter of 2.0 cm (IQR, 1.6–2.8 cm) and 2.5 cm (IQR, 2.2–2.8 cm), respectively. Twenty-one (72.4%) patients were asymptomatic, seven (24.1%) symptomatic, and one (3.4%) presented with rupture. Ten (34.5%) patients had prior aortic surgery. Six (20.7%) were unfit for open surgical repair. Length of stay was 2.0 days (IQR, 1.0–3.0 days). Percutaneous femoral access was performed in 15 (51.7%) patients with no complications. A type IA endoleak was present in one (3.4%), type IB in one (3.4%), and type II endoleak in two (6.9%) patients. There were no postoperative pulmonary, cardiac, or neurological complications. In-hospital mortality occurred in one (3.4%) patient who presented with a rupture and had been deemed unfit for open repair. A conversion to open repair was required. The patient expired on post-operative day 0. Early clinical success was achieved in 26 (89.7%) patients. Follow-up was available for 15 (51.7%) patients at a median time of 766 days (IQR, 653–937). There were no reinterventions or mortalities. Change in sac diameter was −0.6 cm (IQR, −1.1 to −0.2 cm), with no type I or III endoleaks. Discussion Endovascular aneurysm repair for patients with Marfan syndrome is feasible, and can be performed safely. Mid-term outcomes suggest this technique is durable. More robust long-term follow-up is needed.

Long-term follow-up (8 to 17 Years) after thromboexclusion operation for thoracic aortic aneurysms

1997 ◽  
Vol 64 (2) ◽  
pp. 399-403 ◽  
Author(s):  
Kwansong Ku ◽  
Kengo Nakayama ◽  
Yuhei Saitoh ◽  
Seishi Nosaka ◽  
Tadashi Kitano ◽  
...  
Keyword(s):  
Aortic Aneurysms ◽  
Thoracic Aortic Aneurysms ◽  
Long Term Follow Up

Multimodality serial follow-up of thoracic aortic aneurysms

2011 ◽  
Vol 6 (03) ◽  
pp. 153-156 ◽  
Author(s):  
John Rizzo ◽  
Umer Darr ◽  
Michael Fischer ◽  
Kevin Johnson ◽  
John Finkle ◽  
...  
Keyword(s):  
Aortic Aneurysms ◽  
Thoracic Aortic Aneurysms

Association of Fiber Orientation and Dissection Properties of Ascending Thoracic Aortic Aneurysms With Aortic Valve Morphology

2011 ◽  
Author(s):  
Salvatore Pasta ◽  
Julie A. Phillippi ◽  
Antonio D’Amore ◽  
Michael S. Sacks ◽  
Simon C. Watkins ◽  
...  
Keyword(s):  
Aortic Dissection ◽  
Acute Aortic Dissection ◽  
Surgical Techniques ◽  
Aortic Aneurysms ◽  
Type A Aortic Dissection ◽  
Thoracic Aortic Aneurysms ◽  
International Registry ◽  
Life Threatening ◽  
Morbidity Risk ◽  
Emergent Surgery

Type A aortic dissection (AoD) of an ascending thoracic aortic aneurysm (ATAA) is a life-threatening cardiovascular emergency with a high potential for death. Despite improved surgical techniques, the morbidity risk for emergent surgery remains 24% worldwide according to data from the International Registry of Acute Aortic Dissection [1].

scholarly journals Aortic bypass surgery using synthetic conduits in a child with mycotic aneurysmal disease

2016 ◽  
Vol 98 (04) ◽  
pp. e59-e61
Author(s):  
A Sayed ◽  
M Mashaal ◽  
SA Soliman ◽  
H Elwan
Keyword(s):  
Aortic Surgery ◽  
Aortic Aneurysms ◽  
Antifungal Treatment ◽  
Main Concern ◽  
Synthetic Material ◽  
Surgical Interventions ◽  
Aortic Bypass ◽  
Thoracic And Abdominal

A six-year-old child developed multiple aortic aneurysms as a consequence of fungal infection following thoracic aortic surgery for coarctation. Several repairs of both the thoracic and abdominal aorta were carried out using synthetic material combined with long-term postoperative antifungal treatment. We describe the surgical interventions performed and follow-up. The choice of conduit continues to be the main concern; however, when other alternatives are not available, synthetic material combined with indefinite antifungal treatment can produce satisfactory medium-term results.

Aortic Arch Reconstruction by Transluminally Placed Endovascular Branched Stent Graft

Circulation ◽  
1999 ◽  
Vol 100 (suppl_2) ◽  
Author(s):  
Kanji Inoue ◽  
Hiroaki Hosokawa ◽  
Tomoyuki Iwase ◽  
Mitsuru Sato ◽  
Yuki Yoshida ◽  
...  
Keyword(s):  
Aortic Arch ◽  
Stent Graft ◽  
Aortic Aneurysms ◽  
Therapeutic Modality ◽  
Stent Grafts ◽  
Stent Grafting ◽  
Thoracic Aortic Aneurysms ◽  
Stent Graft Repair ◽  
Aortic Dissections

Background —Recently, thoracic aortic stent grafting has emerged as an alternative therapeutic modality for patients with thoracic aortic aneurysms and aortic dissections. However, its application has been limited to descending thoracic aortic aneurysms distal to the aortic arch. We report our initial clinical experience of endovascular branched stent graft repair for aortic arch aneurysms. Methods and Results —Endovascular grafting with Inoue branched stent grafts was attempted for 15 patients with thoracic aortic aneurysms and aortic dissections under local anesthesia (n=14) or general anesthesia (n=1). Single-branched stent grafts were used in 14 patients, and a triple-branched stent graft in one. The branched stent grafts were delivered through a 22F or a 24F sheath under fluoroscopic guidance and implanted across the aneurysmal aortic arch. In 2 patients, the single-branched stent graft did not pass through the 22F sheath used. Complete thrombosis of the aneurysm was ultimately achieved in 11 patients (73%). Of 4 persistent leaks, 1 minor leak spontaneously thrombosed and 1 major leak was successfully treated by additional straight stent graft placement. In 1 patient, the right external iliac artery ruptured during the withdrawal of the sheath and was successfully repaired by the implantation of a straight stent graft. One patient with severe stenosis of the aortic graft section was successfully managed by additional stent deployment. Peripheral microembolization to a toe occurred in 1 patient, and cerebral infarction occurred in 1 other patient. Two patients who had failed to receive endovascular stent grafts died during an average follow-up of 12.6 months, 1 of pneumonia and the other of rupture of a concomitant abdominal aortic aneurysm. Conclusions —This report demonstrates the technical feasibility of endovascular branched stent graft repair for aneurysms located at the aortic arch. Careful, longer follow-up and further extensive clinical trials are awaited toward establishing this technique as a recommendable alternative to surgical treatment of thoracic aortic aneurysms.

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