Outcome Comparison Between Open and Endovascular Aortic Repair for Retrograde Type A Intramural Hematoma With Intimal Tear in the Descending Thoracic Aorta: A Retrospective Observational Study

Objective: The optimal treatment modality for retrograde type A intramural hematoma (IMH) remains debatable. This study evaluated and compared surgical outcomes and aortic remodeling after open aortic repair and thoracic endovascular aortic repair (TEVAR) in patients with retrograde type A IMH with a primary intimal tear or ulcer like projection in the descending aorta.Methods: A single center, retrospective observational study was performed on patients with retrograde type A IMH undergoing either open aortic repair and TEVAR. From June 2009 and November 2019, 46 patients with retrograde type A IMH who received either open aortic repair or TEVAR at our institution were reviewed for clinical outcomes, including post-operative mortality/morbidity, re-intervention rate and aortic remodeling.Results: 33 patients underwent open aortic repair and 13 underwent TEVAR. Median age was 68 years (interquartile range [IQR] 15.2 years) and 63 years (IQR 22.5 years) for the open repair group and TEVAR group, respectively. The median duration of follow-up for TEVAR patients was 37.6 months and 40.3 months for open aortic repair. No difference in the 5-year estimated freedom from all-cause mortality (82.1 vs. 87.8%, p = 0.34), re-intervention (82.5 vs. 93.8%, p = 0.08), and aortic-related mortality (88.9 vs. 90.9%, p = 0.88) were observed between the TEVAR and open repair group, respectively; however, the open repair group had a significantly higher 30-day composite morbidity (39.4 vs. 7.7%, p = 0.037). All patients from both treatment groups had complete resolution of the IMH in the ascending aorta. With regard to the descending thoracic aorta, TEVAR group had a significantly greater regression in the diameter of the false lumen or IMH thickness when compared to the open repair group [median 14mm (IQR 10.1) vs. 5mm (IQR 9.5), p < 0.001].Conclusion: TEVAR and open aortic repair were both effective treatments for retrograde type A IMH, in which no residual ascending aortic IMH was observed during follow-up. TEVAR was also associated with lower post-operative composite morbidities and better descending aortic remodeling. In selected patients with retrograde type A IMH, TEVAR might be a safe, effective alternative treatment modality.

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Thoracic Endovascular Aortic Repair for Retrograde Type A Intramural Hematoma With Intimal Disruption in the Descending Aorta

Journal of Endovascular Therapy ◽

10.1177/15266028211061268 ◽

2021 ◽

pp. 152660282110612

Author(s):

Yingliang Wang ◽

Songlin Song ◽

Chen Zhou ◽

Wenying Zhu ◽

Jiacheng Liu ◽

...

Keyword(s):

Adverse Events ◽

Intramural Hematoma ◽

Type A ◽

Ascending Aorta ◽

Thoracic Endovascular Aortic Repair ◽

Endovascular Aortic Repair ◽

Descending Aorta ◽

Aortic Repair ◽

Intimal Tear

Purpose: To evaluate the safety and efficacy of thoracic endovascular aortic repair (TEVAR) for retrograde type A intramural hematoma (IMH) with intimal disruption in the descending aorta and report our endovascular therapeutic experience. Materials and Methods: From January 2014 to October 2020, a total of 24 consecutive patients with retrograde type A IMH with intimal disruption (intimal tear or ulcer-like projection) in the descending aorta underwent TEVAR. The demographics, clinical characteristics, treatment details, imaging information, and follow-up results were reviewed. Results: Among all patients with retrograde type A IMH, 13 (54.2%) patients presented with ulcer-like projection and 11 (45.8%) with intimal tear (aortic dissection) in the descending aorta. Successful TEVAR was achieved in all patients. There was no 30-day mortality. During a mean follow-up of 37.5 months, 1 patient (4.2%) developed permanent paralysis, 1 patient (4.2%) underwent reintervention due to the expansion of the aorta distal to the stent resulting from the enlargement of distal intimal tear at the 2 month follow up, and no other adverse events were observed. The latest computed tomographic angiography images showed that the maximum diameter of the ascending aorta and descending aorta significantly decreased after TEVAR (both p<0.001), and the IMH/false lumen in the ascending aorta and the descending thoracic aorta were completely absorbed. Conclusion: Thoracic endovascular aortic repair for selected patients with retrograde type A intramural hematoma that presented with intimal disruption in the descending aorta is feasible and efficient, but close surveillance is needed to manage aortic-related adverse events.

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Arterial Stiffness Assessed by Cardio-Ankle Vascular Index in Patients With Abdominal Aortic Aneurysm and Its Alterations After Treatment

Vascular and Endovascular Surgery ◽

10.1177/15385744211023281 ◽

2021 ◽

pp. 153857442110232

Author(s):

Spyridon N. Mylonas ◽

Konstantinos G. Moulakakis ◽

Nikolaos Kadoglou ◽

Constantinos Antonopoulos ◽

Thomas E. Kotsis ◽

...

Keyword(s):

Arterial Stiffness ◽

Surgical Repair ◽

Open Repair ◽

Abdominal Aortic ◽

Gender And Age ◽

Baseline Values ◽

The Difference ◽

The Impact ◽

Repair Group

Purpose: The aim of the present study was to investigate a potential difference on the arterial stiffness among aneurysm patients and non-aneurysm controls, as well as to explore potential changes between patients treated either with endovascular or open repair. Materials and Methods: A 110 patients with an infrarenal AAA were prospectively enrolled in this study. Fifty-six patients received an EVAR, whereas 54 patients received an open surgical repair. Moreover, 103 gender and age-matched subjects without AAA served as controls. The cardio-ankle vascular index (CAVI) was applied for measurement of the arterial stiffness. Results: CAVI values were statistically higher in the AAA patients when compared with control subjects. Although at 48 hours postoperatively the CAVI values were increased in both groups when compared to baseline values, the difference in CAVI had a tendency to be higher in the open group compared to the endovascular group. At 6 months of follow up the CAVI values returned to the baseline for the patients of the open repair group. However, in the endovascular group CAVI values remained higher when compared with the baseline values. Conclusion: Patients with AAAs demonstrated a higher value of CAVI compared to healthy controls. A significant increase of arterial stiffness in both groups during the immediate postoperative period was documented. The increase in arterial stiffness remained significant at 6 months in EVAR patients. Further studies are needed to elucidate the impact of a decreased aortic compliance after stentgraft implantation on the cardiac function of patients with AAA.

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IMPACT OF THORACIC ENDOVASCULAR AORTIC REPAIR TIMING ON AORTIC REMODELING IN ACUTE TYPE B AORTIC INTRAMURAL HEMATOMA

Journal of Vascular Surgery ◽

10.1016/j.jvs.2021.08.059 ◽

2021 ◽

Author(s):

Tomaz Mesar ◽

Fanny S. Alie-Cusson ◽

Maggie J. Lin ◽

David J. Dexter ◽

Animesh Rathore ◽

...

Keyword(s):

Intramural Hematoma ◽

Thoracic Endovascular Aortic Repair ◽

Endovascular Aortic Repair ◽

Acute Type ◽

Type B ◽

Aortic Repair ◽

Aortic Intramural Hematoma ◽

Aortic Remodeling

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Complete Shrinkage of the Obliterated False Lumen After Open and Endovascular Chronic Aortic Dissection Stanford Type A Repair

Aorta ◽

10.12945/j.aorta.2017.16.035 ◽

2017 ◽

Vol 05 (02) ◽

pp. 61-63

Author(s):

George Samanidis ◽

Meletios Kanakis ◽

Constantinos Ieromonachos ◽

George Stavridis

Keyword(s):

Aortic Dissection ◽

Circulatory Arrest ◽

False Lumen ◽

Type A ◽

Frozen Elephant Trunk ◽

Descending Thoracic Aorta ◽

Elephant Trunk ◽

Chronic Aortic Dissection ◽

Antegrade Cerebral Perfusion

AbstractA 48-year-old man was admitted to our hospital with chronic aortic dissection Stanford Type A. His diagnosis was confirmed by chest multi-detector computed tomography (CT). The patient underwent combined (i.e., hybrid) open and endovascular repair (frozen elephant trunk) in a one-stage operation with moderate hypothermic circulatory arrest and antegrade cerebral perfusion. His postoperative course was uneventful, and he was discharged home on postoperative day 9. At 2-year follow-up, chest CT angiography revealed complete shrinkage of the obliterated false lumen in the distal aortic arch and descending thoracic aorta.

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Penetrating Atherosclerotic Ulcers of the Descending Thoracic Aorta May Be Managed Expectantly

Vascular ◽

10.1258/rsmvasc.12.5.307 ◽

2004 ◽

Vol 12 (5) ◽

pp. 307-311

Author(s):

Tarek S. Absi ◽

Thoralf M. Sundt ◽

Cynthia J. Camillo ◽

Richard B. Schuessler ◽

Fernando R. Gutierrez

Keyword(s):

Thoracic Aorta ◽

Intramural Hematoma ◽

Aortic Operation ◽

Descending Thoracic Aorta ◽

Asymptomatic Patients ◽

The Social ◽

Social Security Death Index ◽

History Of ◽

Washington University

The natural history of penetrating atherosclerotic ulcers (PAUs) of the descending thoracic aorta remains unclear. Between January 1996 and June 2000, PAU was diagnosed in 36 patients (16 men, 20 women; mean age 74.9 ± 1.5 years) at Washington University. Imaging studies and hospital records were reviewed. Late follow-up was by search of the Social Security Death Index and telephone interview. None of 16 asymptomatic patients underwent operation. At follow-up (median 457 days), 6 patients had died of unrelated and 2 of unknown causes. Among 20 symptomatic patients, 10 had associated intramural hematoma (5) or dissection (5), of whom 3 underwent operation. At median follow-up (448 days), the 7 unoperated patients remained alive without an aortic operation. Among the remaining 10 symptomatic patients, 3 had an aortic operation and 2 died of unknown causes during follow-up (median 586 days). These data suggest that, in selected cases, PAU may be managed expectantly with careful observation.

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Endovascular Repair for Retrograde Type A Intramural Haematoma with Intimal Tear in the Descending Thoracic Aorta

European Journal of Vascular and Endovascular Surgery ◽

10.1016/j.ejvs.2020.05.021 ◽

2020 ◽

Vol 60 (3) ◽

pp. 386-393 ◽

Cited By ~ 1

Author(s):

Okano Ryoi ◽

Chia-Hsun Lin ◽

Jian-Ming Chen ◽

Yung-Kun Hsieh ◽

Shoei-Shen Wang ◽

...

Keyword(s):

Thoracic Aorta ◽

Endovascular Repair ◽

Type A ◽

Intramural Haematoma ◽

Descending Thoracic Aorta ◽

Intimal Tear

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Outcomes of open and endovascular repair of inflammatory abdominal aortic aneurysms

Vascular ◽

10.1177/1708538117728865 ◽

2017 ◽

Vol 26 (2) ◽

pp. 203-208 ◽

Cited By ~ 1

Author(s):

África Duque Santos ◽

Andrés Reyes Valdivia ◽

María Asunción Romero Lozano ◽

Enrique Aracil Sanus ◽

Julia Ocaña Guaita ◽

...

Keyword(s):

Open Surgery ◽

Aortic Aneurysms ◽

Endovascular Aortic Repair ◽

Abdominal Aneurysm ◽

Aortic Abdominal Aneurysm ◽

Aortic Repair ◽

Number Of Patients ◽

Repair Group

Objective Reports on inflammatory aortic abdominal aneurysm treatment are scarce. Traditionally, open surgery has been validated as the gold standard of treatment; however, high technical skills are required. Endovascular aortic repair has been suggested as a less invasive treatment by some authors offering good results. The purpose of our study was to report our experience and outcomes in the treatment of inflammatory aortic abdominal aneurysm using both approaches. Material and methods A retrospective review and data collection of all patients treated for inflammatory aortic abdominal aneurysm between 2000 and 2015 was done in one academic center. Diagnosis of inflammatory aortic abdominal aneurysm was based on preoperative CT-scan imaging. Type of treatment, postoperative and long-term morbidity and mortality are described. Abdominal compressive symptoms (hydronephrosis) severity and relief after treatment are described. Results Thirty-four patients with intact inflammatory aortic abdominal aneurysm were included. Twenty-nine (85.3%) patients were treated by open means and the remaining five (14.7%) with endovascular aortic repair. Nearly 90% were considered high-risk patients. Median follow-up was 46 months (range 24–112). The two groups were comparable, except for the age and preoperative hydronephrosis. There was no statistical significance in blood transfusion requirements, intensive care hospitalization, 30-day and long-term mortality between the two groups. Preoperative hydronephrosis was diagnosed in four (13.8%) patients in the open surgery group and three (60%) patients in the endovascular aortic repair group. Improvement of hydronephrosis was recognized in three out of the four patients in the open repair group and two out of the three in the endovascular aortic repair group. Renal function remained stable in both groups during follow-up. Conclusions Open surgery remains a safe and valid option for the treatment of inflammatory aortic abdominal aneurysm. Although our study included a small number of patients with endovascular aortic repair treatment, results are promising. Further randomized controlled studies may be necessary to assess long-term effectiveness of endovascular aortic repair treatment in this disease.

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