scholarly journals Association between false lumen segmental arteries and spinal cord ischemia in type A acute aortic dissection

2020 ◽  
Vol 61 (2) ◽  
Author(s):  
Hiroshi Kodama ◽  
Shinya Takahashi ◽  
Takanobu Okazaki ◽  
Shohei Morita ◽  
Seimei Go ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Aortic Dissection ◽  
Acute Aortic Dissection ◽  
Spinal Cord Ischemia ◽  
False Lumen ◽  
Type A ◽  
Segmental Arteries

Cannulating a Dissecting Aorta Using Ultrasound-Epiaortic and Transesophageal Guidance

2011 ◽  
Vol 14 (6) ◽  
pp. 373 ◽  
Author(s):  
Saina Attaran ◽  
Maria Safar ◽  
Hesham Zayed Saleh ◽  
Mark Field ◽  
Manoj Kuduvalli ◽  
...  
Keyword(s):  
Cardiopulmonary Bypass ◽  
Aortic Dissection ◽  
Acute Aortic Dissection ◽  
False Lumen ◽  
Type A ◽  
Ascending Aorta ◽  
Type A Aortic Dissection ◽  
Complete Rupture

<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>

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 Efficacy of entry exclusion strategy for DeBakey type III retrograde Stanford type A acute aortic dissection

2020 ◽  
Author(s):  
Yosuke Inoue ◽  
Hitoshi Matsuda ◽  
Jiro Matsuo ◽  
Takayuki Shijo ◽  
Atsushi Omura ◽  
...  
Keyword(s):  
Aortic Dissection ◽  
Acute Aortic Dissection ◽  
False Lumen ◽  
Type A ◽  
Frozen Elephant Trunk ◽  
Elephant Trunk ◽  
Descending Aorta ◽  
Type Iii ◽  
Elephant Trunk Technique ◽  
Frozen Elephant Trunk Technique

Abstract OBJECTIVES Resection of a primary entry tear is essential for the treatment of Stanford type A acute aortic dissection (AAAD). In DeBakey type III retrograde AAAD (DBIII-RAAAD), resection of the primary entry tear in the descending aorta is sometimes difficult. The frozen elephant trunk technique and thoracic endovascular aortic repair (TEVAR) enable the closure of the primary entry in the descending aorta. The aim of this study was to investigate the efficacy of resection or closure of primary entry, i.e. entry exclusion, in patients with DeBakey type III retrograde-AAAD. METHODS The medical records of 654 patients with AAAD who underwent emergency surgery between January 2000 and March 2019 were retrospectively reviewed, and 80 eligible patients with DeBakey type III retrograde-AAAD were divided into the excluded (n = 50; age, 62 ± 12 years) and residual (n = 30; age, 66 ± 14 years) groups according to postoperative computed tomography angiographic data of the false lumen around the primary entry. The excluded group was defined as having a postoperative false lumen at the level of the elephant trunk or thrombosis of the endograft including primary entry. Patients with early false lumen enhancement around the elephant trunk or an unresected primary entry tear after isolated hemiarch replacement were included in the residual group. The early and long-term surgical outcomes were compared between the groups. RESULTS The in-hospital mortality rate was 8% (6/80), with no significant difference observed between the excluded and the residual groups (10% and 7%, respectively; P &gt; 0.99). Ninety-five percentage of the patients (20/21) achieved entry exclusion with stent grafts including the frozen elephant trunk procedure and TEVAR. Spinal cord ischaemia was not observed in either group. The cumulative overall survival at 5 years was comparable between the 2 groups (76% and 81% in the excluded and residual groups, respectively; P = 0.93). The 5-year freedom from distal aortic reoperation rate was significantly higher in the excluded group (97%) than in the residual group (97% vs 66%; P = 0.008). CONCLUSIONS Not only resection but also closure using the entry exclusion approach for DeBakey type III retrograde-AAAD utilizing new technologies including the frozen elephant trunk technique and TEVAR might mitigate dissection-related reoperations.

scholarly journals Strategy for Stanford Type A Acute Aortic Dissection with Thrombosed False Lumen of the Ascending Aorta.

2001 ◽  
Vol 30 (6) ◽  
pp. 280-284
Author(s):  
Hidefumi Obo ◽  
Tsutomu Shida ◽  
Syuuichi Kozawa ◽  
Tatsurou Asada ◽  
Nobuhiko Mukohara ◽  
...  
Keyword(s):  
Aortic Dissection ◽  
Acute Aortic Dissection ◽  
False Lumen ◽  
Type A ◽  
Ascending Aorta

P5607Clinical characteristics and treatment strategy for acute aortic dissection in Tokyo Acute Aortic Disease Super-Network System

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
H Yoshino ◽  
K Akutsu ◽  
T Takahashi ◽  
T Shimokawa ◽  
H Ogino ◽  
...  
Keyword(s):  
Aortic Dissection ◽  
Hospital Mortality ◽  
Treatment Strategy ◽  
Acute Aortic Dissection ◽  
False Lumen ◽  
Type A ◽  
Network System ◽  
Care Hospital ◽  
Type B ◽  
New System

Abstract Introduction Acute aortic dissection (AAD) is one of the most fatal cardiovascular diseases. The prevalence of AAD is reported to be low. The clinical data of AAD from representative cardiovascular centers are not enough to show the whole range of clinical feature of AAD. We have to know the exact prevalence and clinical pictures of AAD under the new system, the Tokyo AAD Super-Network System (TAAD-SNS), for strategy of emergency transport and treatment of AAD which would cover the entire metropolitan area of Tokyo. TAAD-SNS started in 2011, and after slight modification, the new system of AAD re-started in 2013. The aim of this study is to elucidate the whole range of clinical characteristics and recent trends of treatment of AAD. Methods Out of 73 hospitals included in Tokyo CCU Network system, 41 hospitals are chosen for TAAD-SNS. These hospitals provide around-the-clock surgery. In this system, the availability of surgical division is monitored in real time. All of the patients suspected of AAD are transferred directly or from primary care hospital to the hospitals of TAAD-SNS. Results After exclusion of 237 patients with cardiopulmonary arrest on arrival, 4877 consecutive patients (2923 male, mean age of 69±14 y/o) were admitted to the hospitals with diagnosis of AAD from 2013 to 2016. Prevalence of AAD in Tokyo was about 10 patients per 100,000 populations in every year. After exclusion of 37 patients undetermined into type A or B, 4840 patients (2694 with type A and 2146 with type B) were analyzed. Among the type A patients, 1752 (65%) were classified into type of patent false lumen (classic-type), 721 (27%) of closed false lumen (intramural hematoma: IMH-type), and 221 (8%) were undetermined. Among the type B, 880 (41%) were classified into classic-type, 1129 (53%) of IMH-type, and 137 (6%) were undetermined. Both among type A and B, mean ages were younger in classic-type than in IMH-type (type A: 66±14 vs. 73±12 y/o, p<0.05; type B: 64±15 vs. 72±12 y/o, p<0.05). Prevalence of male population and risk factor of hypertension was higher in type B than in type A both among classic-type and IMH-type. Systolic blood pressure at the emergency room was lower in type A than in type B among both classic-type and IMH-type (classic-type: 124±34 vs. 161±38 mmHg, IMH-type: 130±51 vs. 163±56 mmHg). In-hospital mortality of surgical treatment for type A classic-type and type A IMH-type, conservative strategy for type B classic-type and type B IMH-type was 9.6%, 4.2%, 3.1% and 1.7%, respectively. Stentgraft implantation for type B AAD started and shows a favorable in-hospital mortality compared to the operative treatment (Stentgraft vs. surgery in type B classic-type: 7.8% vs. 6.5%, in type B IMH-type: 10.7% vs. 11.8%, respectively). Conclusion Our study showed that prevalence of AAD was 2–3 times higher than previous reports. We should consider to choose the treatment strategy according to the type of AAD, A or B, classic-type or IMH-type. Acknowledgement/Funding Tokyo Metropolitan government

scholarly journals SPINAL CORD ISCHEMIA IN SURGICALLY TREATED ACUTE AORTIC DISSECTION: WHO'S AT RISK?

2011 ◽  
Vol 57 (14) ◽  
pp. E1523
Author(s):  
Anton Camaj ◽  
Santi Trimarchi ◽  
Daniel Montgomery ◽  
Elise Woznicki ◽  
Christoph A. Neinauber ◽  
...  
Keyword(s):  
Spinal Cord ◽  
At Risk ◽  
Aortic Dissection ◽  
Acute Aortic Dissection ◽  
Spinal Cord Ischemia

scholarly journals Aortic dissection in Siriraj patients: Computed tomography findings

2017 ◽  
Vol 19 (3) ◽  
pp. 5-25
Author(s):  
Krisdee Prabhasavat ◽  
Sukrit Sorotpinya ◽  
Jitladda Wasinrat ◽  
Somchai Chairoongruang
Keyword(s):  
Aortic Dissection ◽  
Acute Aortic Dissection ◽  
False Lumen ◽  
Type A ◽  
Outer Wall ◽  
Type B ◽  
Computed Tomographic ◽  
Wall Calcification ◽  
Acute Dissection ◽  
Aortic Dissections

Background: CTA has replaced angiography in both diagnosis and evaluation of aortic dissection. Most findings are associated with true and false lumens which account for the most important information in both diagnosis and management. Objective: To describe computed tomographic (CT) findings including types based on Stanford classification, true and false lumens, acute and chronic aortic dissections, relation to origins of aortic branches, complications and other related findings. Methods: Computed tomographic angiography (CTA) scans of one hundred and twenty patients with aortic dissection during 2007 to 2016 were retrospectively reviewed. The findings indicating types, true and false lumens, acute and chronic, origination of aortic branches, complication and other related findings are categorized. Result: Most true lumens were smaller, having outer wall calcification. Most false lumens were larger, showing beak sign, cobweb sign, and intraluminal thrombi. However, the larger lumens could be true lumens as well as the smaller lumen could be a false lumen and outer wall calcification could be seen in a false lumen. The larger true lumens and the smaller false lumens with outer wall calcifications were more often found in chronic aortic dissection than acute aortic dissection. Both acute and chronic aortic dissections were more Stanford type B than type A. Complications included rupture, hemopericardium, hemothorax, hemomediastinum and distal organ infarction, which were more frequent in acute dissection. Intrathoracic complications were more commonly caused by type A acute dissection. Renal infarction was the most common complication in type B acute aortic dissection. Conclusion: Most CT fi ndings of aortic dissection in this study were typical. Atypical fi ndings were also found in both acute and chronic aortic dissections. Outer wall calcifi cations of false lumens in acute aortic dissection were found in 2 cases.

scholarly journals Hybrid Stepwise External Wrapping for Type A Acute Aortic Dissection with Cerebral Malperfusion

2020 ◽  
Author(s):  
Yoshihiro Suematsu ◽  
Satoshi Nishi ◽  
Daisuke Arima ◽  
Akihiro Yoshimoto
Keyword(s):  
Aortic Dissection ◽  
Acute Aortic Dissection ◽  
Aortic Rupture ◽  
False Lumen ◽  
Type A ◽  
Good Physical Condition ◽  
Threatening Condition ◽  
Valve Insufficiency ◽  
Life Threatening ◽  
Cerebral Malperfusion

Abstract Background: Acute aortic dissection (AAD) is a life-threatening condition which can lead to coronary, brachiocephalic or branch vessel malperfusion, as well as aortic valve insufficiency, or aortic rupture. Mortality of surgical treatment in high-risk or elderly patients with Type A AAD (TAAAD) still remains high, and treatment for such patients remains controversial. We report a successful treatment of TAAAD with a communicating false lumen in a 60-year-old man with acute hemi-cerebral malperfusion. Case presentation: The ascending aorta was wrapped with stepwise external wrapping (SEW) procedure, and subsequent thoracic endovascular aortic repair (TEVAR) was successfully performed. The patient was discharged in good physical condition without any complications. Conclusions: Hybrid therapy with SEW and TEVAR with TAAAD associated with major cerebral malperfusion should be considered, especially in patients for whom open surgery is extremely risky.

scholarly journals A preoperative mortality risk assessment model for Standford type A acute aortic dissection

2020 ◽  
Author(s):  
Juntao Kuang ◽  
Jue Yang ◽  
Qiuji Wang ◽  
Changjiang Yu ◽  
Ying Li ◽  
...  
Keyword(s):  
Risk Assessment ◽  
Aortic Dissection ◽  
Mortality Risk ◽  
Acute Aortic Dissection ◽  
False Lumen ◽  
Type A ◽  
Assessment Model ◽  
Imaging Features ◽  
Risk Assessment Model ◽  
Aortic Dissection Type A

Abstract OBJECTIVES Acute aortic dissection type A is a life-threatening disease required emergency surgery during acute phase. Different clinical manifestations: laboratory tests: and imaging features of patients with acute aortic dissection type A are the risk factors of preoperative mortality. This study aims to establish a simple and effective preoperative mortality risk assessment model for patients with acute aortic dissection type A. METHODS A total of 508 Chinese patients with acute aortic dissection type A who were admitted to our hospital were retrospectively included. All patients were unable to receive surgically treatment within 3 days from the onset of disease. Multivariable analysis was used to investigate predictors of preoperative mortality and to develop a prediction model. RESULTS Among the 508 patients: 394 patients survived (77.56%) and 114 patients died (22.44%). The following independent variables increased preoperative mortality: initial pain site: chest (OR = 7.536: P = 0.021): D-Dimmer ≥ 12000 ng/ml (OR = 2.982: P < 0.001): the average ascending diameter measured by transthoracic echocardiography ≥ 55 mm (OR = 4.226: P < 0.001): moderate or massive pericardial effusion (OR = 2.534: P = 0.040): electrocardiographic myocardial ischemia (OR = 3.355: P < 0.001): patent false lumen (OR = 2.808: P < 0.001): right common carotid artery involvement (OR = 4.415: P < 0.001): false lumen /true lumen of abdominal aorta ≥ 0.75 (OR = 2.310: P = 0.011). Our data suggest that a simple and effective preoperative death risk assessment model has been established. CONCLUSIONS Using a simple and effective risk assessment model can help clinicians quickly identify high-risk patients and make appropriate medical decisions.

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