scholarly journals Simple Hepatic Cysts as Markers of Thoracic Aortic Disease

2021 ◽  
Vol 6 (1) ◽  
Author(s):  
Kim C ◽  
◽  
Ziganshin BA ◽  
Zafar MA ◽  
Buntin J ◽  
...  
Keyword(s):  
Positive Family History ◽  
Type A ◽  
Aortic Disease ◽  
Control Group ◽  
Clinical Markers ◽  
Type B ◽  
Thoracic Aortic Disease ◽  
Hepatic Cysts ◽  
Type B Dissection ◽  
Type A Dissection

Objective: Thoracic Aortic Disease (TAD) is potentially lethal, yet difficult to detect as most patients are asymptomatic until the aneurysm dissects and becomes life threatening. Several clinical markers for TAD have been identified such as: bicuspid aortic valve, intracranial aortic aneurysm, bovine aortic arch, positive family history, and simple renal cysts. The aim of this study was to investigate the prevalence of Simple Hepatic Cysts (SHC) among individuals diagnosed with TAD in order to assess whether they can be used as a predictor of TAD. Methods: In this retrospective study, the prevalence of SHC for (n=1244) hospital patients treated for TAD was evaluated and compared to a control group of (n=809) patients. TAD patients were divided into four subgroups: ascending aneurysm (788; 63.3%; descending aneurysm (123; 9.9%); type A dissection (137; 11%); type B dissection (196; 15.8%). The presence of SHC was determined based on either computed tomography, magnetic resonance imaging, or ultrasound imaging of these patients. Results: Prevalence of SHC was 14.8%, 11.4%, 12.4%, and 14.8% in patients with ascending aneurysm, descending aneurysm, type A dissection, and type B dissection, respectively. Prevalence of SHC in the control group was 3.8% (p<0.001). The prevalence of SHC was not significantly different between males and females among the TAD patients as well as the control population. Conclusion: Individuals with TAD have an increased prevalence of SHC compared to individuals without TAD. SHC can potentially be used as a clinical marker to detect patients at risk for TAD.

scholarly journals Typical Retrograde Type A Dissection After Previous Type B Dissection

2021 ◽  
Vol 24 (3) ◽  
pp. E589-E592
Author(s):  
Zeyi Cheng ◽  
Jun Shi ◽  
Caixia Pe ◽  
Yingqiang Guo
Keyword(s):  
Back Pain ◽  
Type A ◽  
Endovascular Stent ◽  
Type B ◽  
Type B Aortic Dissection ◽  
Type B Dissection ◽  
Type A Dissection ◽  
Stent Graft Implantation ◽  
Stanford Type B ◽  
Graft Implantation

Background: Stanford type B aortic dissection (TBAD) retrograde tears to Stanford type A AD (RTAAD) have been reported only rarely, but are often fatal. Early diagnosis and timely surgery are essential. We present a typical case of RTAAD after the tip of the stent directly damaged the ascending aorta wall. Case: A 71-year-old woman was admitted to our department for chest pain and back pain for 10 hours. She had undergone coated stent graft implantation surgery a month previously for TBAD. On first impression, we suspected the AD may have progressed or torn retrogradely. RTAAD was confirmed by computed tomography angiography, and we successfully performed open surgery. Conclusion: RTAAD should be suspected in patients with chest and back pain after endovascular stent repair. Prompt recognition is essential, and early surgical treatment is strongly recommended.

scholarly journals 4D flow MRI of type B dissection with later retrograde progression to type A dissection in Marfan: a case report

2021 ◽  
Vol 5 (8) ◽  
Author(s):  
Max J P van Hout ◽  
Joe F Juffermans ◽  
Arthur J Scholte ◽  
Hildo J Lamb
Keyword(s):  
Risk Assessment ◽  
Subclavian Artery ◽  
Left Subclavian Artery ◽  
False Lumen ◽  
Type A ◽  
Acute Type ◽  
Type B ◽  
4D Flow ◽  
Type B Dissection ◽  
Type A Dissection

Abstract Background  Due to the malfunction of connective tissue, Marfan patients are at increased risk of aortic dissection. Uncomplicated acute type B dissection is usually managed with medical therapy. Retrograde progression or new type A dissection is a relatively rare but often fatal complication that occur most frequently in the first 6 months after acute type B dissection. Case summary  We present a 31-year-old male with Marfan syndrome and a recent uncomplicated type B dissection from the left subclavian to the right common iliac artery who underwent 4D flow magnetic resonance imaging (MRI). The dissection had a large proximal intimal tear just distal to the left subclavian artery (15 mm) and large false lumen (35 mm). Aortic blood flow just distal to the left subclavian artery (3.6 L/min) was split disproportionately into the true (0.8 L/min, 22%) and false lumen (2.8 L/min, 78%). 4D flow streamlines revealed vortical flow in the proximal false lumen. Increased wall shear stress was observed at the sinotubular junction (STJ), inner wall of the ascending aorta and around the subclavian artery. Two weeks after MRI, the patient presented with jaw pain. Computed tomography showed a type A dissection with an entry tear at the STJ for which an acute valve-sparing root, ascending and arch replacement was performed. Discussion  Better risk assessment of life-threatening complications in uncomplicated type B dissections could improve treatment strategies in these patients. Our case demonstrates that besides clinical and morphological parameters, flow derived parameters could aid in improved risk assessment for retrograde progression from uncomplicated type B dissection to acute type A dissection.

scholarly journals Delayed type A dissection after arch transposition and stent graft therapy of a type B dissection

2009 ◽  
Vol 138 (4) ◽  
pp. 1031-1032
Author(s):  
Curtis A. Anderson ◽  
Evelio Rodriguez ◽  
Michael C. Stoner ◽  
Alan P. Kypson
Keyword(s):  
Stent Graft ◽  
Type A ◽  
Type B ◽  
Type B Dissection ◽  
Type A Dissection

scholarly journals Retrograde Stanford type A dissection caused by a multilayer stent graft in a patient with chronic type B dissection

2018 ◽  
Vol 28 (4) ◽  
pp. 655-656 ◽  
Author(s):  
Myriam Johanna Schafigh ◽  
Zaki Kohistani ◽  
Wolfgang Schiller ◽  
Chris Probst
Keyword(s):  
Stent Graft ◽  
Type A ◽  
Type B ◽  
Chronic Type ◽  
Type B Dissection ◽  
Multilayer Stent ◽  
Type A Dissection

Aortic emergencies

2015 ◽  
Author(s):  
Parla Astarci ◽  
Laurent de Kerchove ◽  
Gébrine el Khoury
Keyword(s):  
Type A ◽  
Limb Ischaemia ◽  
Acute Type ◽  
Type B ◽  
Endovascular Techniques ◽  
Stent Grafts ◽  
Term Survival ◽  
Acute Aortic Syndromes ◽  
Type B Dissection ◽  
Type A Dissection

Acute aortic dissections account for the leading and most feared of aortic emergencies. Acute dissections are associated with a dreadful mortality rate; therefore, an accurate diagnosis and immediate treatment are mandatory. The key point of a lifesaving management strategy is the distinction between acute type A dissection, uncomplicated type B dissection, and complicated type B dissection, and those including contained ruptured aorta (severe pleural effusion) and/or malperfusion syndrome (by end-organ ischaemia: paraplegia, intestinal ischaemia, renal insufficiency, limb ischaemia). Type A generally requires urgent surgery; uncomplicated type B dissections are treated conservatively, while complicated type B dissections are currently managed by means of minimally invasive endovascular techniques, eventually associated with a tight surgical time (e.g. in the case of limb ischaemia). Surgical repair of type A dissection consists of the replacement of the ascending aorta. The repair is extended proximally towards the aortic root and valve, and distally towards the aortic arch, in function of the lesions found and the clinical presentation of the patient (haemodynamic status, age, comorbidities). The emergence of endovascular techniques and the contribution of thoracic endovascular aortic repair, with thoracic stent-grafts deployed from the proximal descending aorta to reopen the true lumen and to seal the entry tear in type B dissections, have revolutionized the surgical treatment algorithm in this pathology, and thus the patient’s immediate and medium-term survival. In the same group of acute aortic syndromes, traumatic aortic isthmic ruptures are also life-threatening conditions and account for one of the main causes of death at the time of traumatic accidents. As in the case of complicated type B dissections, the introduction of aortic stent-grafts has changed the outcome of these patients.

Abstract 280: Cocaine-Related Aortic Dissection: Lessons from the International Registry of Acute Aortic Dissection

2013 ◽  
Vol 6 (suppl_1) ◽  
Author(s):  
Joshua H Dean ◽  
Patrick O’Gara ◽  
Daniel G Montgomery ◽  
Santi Trimarchi ◽  
Truls Myrmel ◽  
...  
Keyword(s):  
Aortic Dissection ◽  
Tobacco Use ◽  
Acute Aortic Dissection ◽  
Type A ◽  
Type B ◽  
Cocaine Use ◽  
International Registry ◽  
Type B Dissection ◽  
History Of ◽  
Type A Dissection

Background: Acute Aortic Dissection (AAD) associated with cocaine use is a rare event for which only limited case reports and small cohort studies are available. This study compares demographics, history, presenting symptoms and in-hospital outcomes among AAD patients with a history of cocaine use (C+) to those of patients without a history of cocaine use (C-) in a large international registry. Methods: Our study analyzed 3584 patients enrolled in the International Registry of Acute Aortic Dissection from 1996 to 2012. We divided the population based on documented cocaine use and further stratified patients into Type A (33 C+/2332, 1.4%) and Type B (30 C+/1252, 2.4%) dissection cohorts. Results: C+ patients presented at a younger age and were more likely to be male and black for both Type A and B dissections. Type B dissection was more common among C+ patients than in C- patients. Cocaine-related AAD was reported more often at US sites compared to European sites (86.4% 51/63 v. 13.6% 8/63, p<0.001). Tobacco use was more prevalent in the C+ cohort. No differences were seen in history of hypertension, known atherosclerosis or time from symptom onset to presentation between cohorts. Type B C+ patients were more likely to be hypertensive at presentation. Both Type A and Type B C+ cohorts had significantly smaller ascending aortic diameters than C- patients. Acute renal failure was more common in Type A C+ patients but mortality was significantly lower in Type A C+ patients vs type C- patients for reasons than could not be identified from the data base. Conclusions: Cocaine abuse is implicated in approximately 2% of patients with acute aortic dissection. The typical patient is a relatively young male cigarette smoker, who like the majority of patients with AAD, has a history of hypertension. In hospital mortality for cocaine-related Type A dissection is lower than that seen with non-cocaine related type A dissection. The combination of tobacco use, cocaine use, and hypertension may predispose patients to AAD who may otherwise have little risk for the condition.

Abstract TP144: Mechanisms And Prognosis Of Acute Ischemic Stroke Related To Acute Aortic Dissection

Stroke ◽  
2013 ◽  
Vol 44 (suppl_1) ◽  
Author(s):  
Seung-Jae Lee ◽  
Dong-Suk Shim ◽  
Si-Ryung Han
Keyword(s):  
Ischemic Stroke ◽  
Aortic Dissection ◽  
Early Onset ◽  
Acute Aortic Dissection ◽  
Type A ◽  
Posterior Circulation ◽  
Type B ◽  
Delayed Onset ◽  
Bilateral Carotid ◽  
Type B Dissection

Background: Acute aortic dissection (AD) is one of the lethal cardiac diseases involving the aorta. Although pain is a typical symptom, stroke may not rarely occur with the occlusive dissection of aortic branches or hypotension under the condition of AD. We attempted to explores the clinical features, possible mechanisms and prognosis of acute ischemic stroke (AIS) related to AD Method: Medical records of 278 consecutive patients with AD (165 with type A and 113 with type B dissection) over 11.5 years were retrospectively analyzed for clinical history, CT or MRI findings and outcome. AIS were categorized into early- or delayed-onset stroke. Early-onset stroke was defined as an AIS presented at admission, and delayed-onset stroke was an AIS which were developed during the two months after the first admission. Results: 26 (9.4%) patients experienced an ischemic stroke, which included 22 with type A and 4 with type B dissection. 8 patients (2.9%) including a case of TIA had an early-onset stroke, whereas delayed-onset stroke occurred in 18 patients (6.5%) postoperatively or under medical treatment. Early-onset stroke was all referable to the anterior circulation, predominantly right-sided (87.5%). One or more main branches of the aortic arch were involved in 6 out of 8 patients (75%) with early-onset stroke. Innominate artery was most frequently involved (75.0%). In contrast, delayed-onset stroke affected similarly bilateral carotid territories, and also included lesions in bilateral carotid, posterior-circulation and anterior/posterior-circulation territories. Among the 26 patients, 8 patients (30.8%) expired within 6 months of the disease onset (3 cases from hemispheric stroke with brain herniation, 2 cases from aortic rupture, 2 cases from sepsis with multiple organ failure and a case from mesentery ischemia and renal failure). Additionally, 9 patients (34.6%) remained functionally dependent six months later. Conclusion: AD not infrequently causes AIS with grave prognosis, especially in patients with type A dissection. The presumed mechanisms were aortic branch dissection causing luminal occlusion and emboli from thrombosed vascular lumen and hypotension under the condition of AD.

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