scholarly journals Review of Studies Reporting the Incidence of Acute Type B Aortic Dissection

Hearts ◽  
2020 ◽  
Vol 1 (3) ◽  
pp. 152-165
Author(s):  
Marcus Brooks
Keyword(s):  
Aortic Dissection ◽  
English Language ◽  
Hospital Admissions ◽  
Road Traffic ◽  
Acute Type ◽  
Type B ◽  
Cross Sectional ◽  
Aortic Replacement ◽  
Type B Dissection

Aortic dissection (AD) causes more deaths each year in the United Kingdom than road traffic collisions. Yet the incidence of AD is not known. The management of acute type B AD (TBAD) is changing, with the greater use of thoracic aortic stent grafts (TEVAR) in treatment and fewer open surgical procedures performed. The study’s aim is to review the worldwide, English language published, literature on acute TBAD incidence and treatment, to report on its strengths and limitations, and better understand changes in incidence over time and between countries. Thirty-one studies were identified that focus on the epidemiology and treatment of TBAD. Eight of these studies report the incidence of acute TBAD as between of 0.5–6.3 per 100,000 person years. Hospital admissions for aortic dissection are reported to be increasing in six studies and stable in one study. The proportion of patients with TBAD operated on varies between studies (range 13% to 76%). Studies identify patient age (median 51–77 years), gender (range 48%–81% male) and prevalence of cardio-vascular risk factors, specifically hypertension, in the populations studied as independent factors influencing aortic dissection incidence. Treatment of acute TBAD remains largely conservative with analgesia, hypertension control and serial cross-sectional imaging (range 24%–87% TBAD medically treated). The use of TEVAR to treat acute AD is increasing worldwide (range 13%–76% TBAD treated with TEVAR). The incidence of TBAD is under-reported due to out of hospital deaths, variable clinical presentation (miss-diagnosis) and coding errors. Importantly for research, the single International Classification of Diseases (ICD) code for aortic dissection, I17.0, does not distinguish between acute, chronic, type A or type B dissection types. Similarly, the OPCS Classification of Interventions and Procedures version 4 (OPCS-4) codes for TEVAR, L27.4 and L28.4, do not distinguish between acute and chronic AD presentation, unlike the codes for open thoracic aortic replacement. Standardised reporting of aortic dissection type, and the urgency of both the initial presentation (acute or chronic) and treatment (emergency, urgent or planned) in future studies would allow more meaningful comparisons between populations.

scholarly journals 3067 Biomechanical analysis of acute versus chronic aortic dissection flaps

2019 ◽  
Vol 3 (s1) ◽  
pp. 102-102
Author(s):  
Xiaoying Lou ◽  
Wei Sun ◽  
Fatiesa Sulejmani ◽  
Minliang Liu ◽  
Edward Chen ◽  
...  
Keyword(s):  
Aortic Dissection ◽  
Collagen Fiber ◽  
Longitudinal Direction ◽  
Biomechanical Analysis ◽  
Percentage Error ◽  
Acute Type ◽  
Type B ◽  
Chronic Type ◽  
Aortic Replacement ◽  
Fiber Organization

OBJECTIVES/SPECIFIC AIMS: Thoracic endovascular aortic repair (TEVAR) is more effective in remodeling the dissected aorta in acute versus chronic type B aortic dissection (TBAD). It has been hypothesized that this is due to differences in dissection flap biomechanical and structural properties but has not been confirmed in explanted human aortic tissue. We aimed to characterize and compare differences in tissue biomechanics and microstructure between acute and chronic dissection flaps that may underlie these findings. METHODS/STUDY POPULATION: Dissection flaps were obtained at time of operative repair for patients presenting for open aortic replacement to treat acute type A (ACUTE, n=7) or chronic type B (CHRONIC, n=7) aortic dissection. Given that the current treatment modality for acute complicated TBAD is TEVAR, it was not feasible to acquire acute TBAD flaps for analysis. Tissues were cryopreserved and subjected to biaxial tensile testing in the circumferential and longitudinal directions. Stiffness was quantified by the tangent modulus (TM) in the low and high linear regions of the compiled equibiaxial response curves for each cohort. Extensibility was defined as the intersection of the fitted line from the high linear region with the x-axis, and the degree of anisotropy (DA) was defined as the mean absolute percentage error of the strains in both directions. Flap architecture and collagen fiber organization were also compared between groups using two-photon microscopy. RESULTS/ANTICIPATED RESULTS: Average age of dissection flaps were 3.4±3.4 days in ACUTE and 1,868.7±1,354.0 days in CHRONIC (p=0.011). There were no differences in age, co-morbidities, maximum aortic diameter, and aortic wall thickness. ACUTE exhibited an anisotropic stress-strain response with increased extensibility longitudinally than circumferentially (0.18 vs. 0.09, p=0.022, DA=0.67) while CHRONIC demonstrated an isotropic response with similar extensibility in either direction (0.11 vs. 0.12, p=0.606, DA=0.26). CHRONIC and ACUTE had comparable stiffness in the circumferential direction (TMlow 439.92 vs. 541.08, p=0.729, and TMhigh 1585.19 kPa vs. 1869.35 kPa, p=0.817). In the longitudinal direction, CHRONIC was significantly stiffer than ACUTE (TMhigh 8347.61 kPa vs. 1201.34 kPa, p=0.049) (FIGURE). Microscopy corroborated these findings with greater collagen fiber organization circumferentially than longitudinally in ACUTE and increasing fibrosis, collagen predominance, and straightening of collagen fibers in CHRONIC. DISCUSSION/SIGNIFICANCE OF IMPACT: Compared to ACUTE, CHRONIC exhibited loss of anisotropy with increased tissue stiffness in the longitudinal direction. Increased dissection flap fibrosis and decreased compliance may explain the worse outcomes for aortic remodeling after TEVAR in chronic TBAD. This study offers biomechanical support for early TEVAR in the acute phase of uncomplicated TBAD.

Ascending Thoracic Aorta Dimension and Outcomes in Acute Type B Dissection (from the International Registry of Acute Aortic Dissection [IRAD])

2011 ◽  
Vol 107 (2) ◽  
pp. 315-320 ◽  
Author(s):  
Anna M. Booher ◽  
Eric M. Isselbacher ◽  
Christoph A. Nienaber ◽  
James B. Froehlich ◽  
Santi Trimarchi ◽  
...  
Keyword(s):  
Aortic Dissection ◽  
Thoracic Aorta ◽  
Acute Aortic Dissection ◽  
Acute Type ◽  
Type B ◽  
International Registry ◽  
Type B Dissection

scholarly journals Arc of Buhler: A lifesaving anatomic variation. A case report

2020 ◽  
Vol 19 ◽  
Author(s):  
Schizas Nikolaos ◽  
Patris Vasilios ◽  
Lama Niki ◽  
Eleftherios Orestis Argyriou ◽  
Kratimenos Theodoros ◽  
...  
Keyword(s):  
Case Report ◽  
Aortic Dissection ◽  
Blood Supply ◽  
Anatomic Variation ◽  
Anatomical Variation ◽  
Celiac Artery ◽  
Acute Type ◽  
Type B ◽  
Type B Aortic Dissection ◽  
Type B Dissection

Abstract The presence of malperfusion syndrome in cases of complicated acute type B aortic dissection is a negative predictive factor and urgent intervention is indicated. Anatomic variations, such as the Arc of Buhler, contribute anastomotic channels and can preserve the visceral blood supply. In this case report, we describe the overall management of a 54-year-old man who presented with a type B aortic dissection. Initially, conservative management was chosen, as indicated for an uncomplicated type B dissection, but the dissection deteriorated. Despite the fact that severe occlusion of the celiac artery was detected on Computed Tomography (CT) angiography, the Arc of Buhler anatomical variation was present, contributing adequate visceral blood supply. After considering this finding, the patient was treated effectively with thoracic endovascular aortic repair (TEVAR).

Adult untreated coarctation of the aorta developing acute type B dissection

2019 ◽  
Vol 28 (2) ◽  
pp. 120-122 ◽  
Author(s):  
Koji Tsutsumi ◽  
Takuya Yasuda ◽  
Osamu Ishida
Keyword(s):  
Aortic Dissection ◽  
Surgical Repair ◽  
Coarctation Of The Aorta ◽  
Acute Type ◽  
Type B ◽  
Type B Aortic Dissection ◽  
Descending Aorta ◽  
Type B Dissection ◽  
Aorta Replacement ◽  
Intimal Tear

Development of acute type B aortic dissection in an adult patient with untreated coarctation of the aorta is a rare phenomenon. A 62-year-old man was incidentally found to have coarctation of the aorta when he was suffered a type B aortic dissection. Initially, he was treated medically, but the diameter of the proximal descending aorta was progressively expanding. Descending aorta replacement followed by excision of the coarctation and intimal tear were performed electively. Surgical repair resulted in a good outcome.

Type A Aortic Dissection Developing During Endovascular Repair of an Acute Type B Dissection

2003 ◽  
Vol 10 (2) ◽  
pp. 254-259 ◽  
Author(s):  
Fabrizio Fanelli ◽  
Filippo Maria Salvatori ◽  
Giulia Marcelli ◽  
Mario Bezzi ◽  
Marco Totaro ◽  
...  
Keyword(s):  
Aortic Dissection ◽  
Endovascular Repair ◽  
Type A ◽  
Acute Type ◽  
Type B ◽  
Type A Aortic Dissection ◽  
Type B Dissection

Current evidence for thoracic aorta type B dissection management

Vascular ◽  
2013 ◽  
Vol 22 (6) ◽  
pp. 439-447 ◽  
Author(s):  
Laura Capoccia ◽  
Vicente Riambau
Keyword(s):  
Aortic Dissection ◽  
Current Evidence ◽  
Acute Type ◽  
Type B ◽  
Chronic Complications ◽  
The Poor ◽  
Time Period ◽  
Type B Dissection ◽  
Long Term Prognosis

Aortic dissection is a devastating cardiovascular condition and represents the most common aortic emergency. Outcome is determined by the type and extent of dissection and the presence of associated complications requiring early diagnosis and treatment. Aortic dissection is defined as acute within 14 days from onset and chronic after that time period. The natural course of type B dissection is determined by 2 elements, early and chronic complications. An uncomplicated acute type B dissection is less frequently lethal but it is not totally benign. Some peculiar issues must be taken into account, such as the high probability of complications development in a dissected aorta and the poor long-term prognosis on medical treatment alone. Then, it would be helpful to identify which patients with uncomplicated type B dissection will have a poorest aortic prognosis over time in order to apply an early intervention.

scholarly journals Classification of Dissecting Aortic Aneurysm as a Guide for Surgical Management

2020 ◽  
pp. 61-68
Author(s):  
L. Kulyk ◽  
D. Beshley ◽  
I. Protsyk ◽  
S. Lishchenko ◽  
V. Pezentiy ◽  
...  
Keyword(s):  
Aortic Aneurysm ◽  
Aortic Dissection ◽  
Surgical Management ◽  
Limb Ischemia ◽  
Type A ◽  
Aortic Aneurysms ◽  
Common Denominator ◽  
Acute Type ◽  
Type B Dissection

Mortality in acute dissecting type A aortic aneurysm remains high. The existing classifications are intended to give an accurate, and, very importantly (given the acute course of the pathology), a prompt answer to the clinician’s and the cardiac surgeon’s questions: how the patients should be treated, and which of them should undergo surgical intervention, and which procedure is to be used. Aim. A review and analysis of the existing classifications of dissecting aortic aneurysms and their transformation taking into account the advances in diagnostic technologies and methods of surgical management. The first classification was proposed by DeBakey; it systematized morphological variants of the disease and explained the origin of its accompanying phenomena such as heart tamponade, acute aortic valve insufficiency, and visceral and limb ischemia, but provided no guidelines on treatment techniques. A more recent Stanford classification was based on the principle of differentiation into conservative or operative approach. Owing to the use of CT and MRI angiography, new dissection subtypes were discovered and formulated in the Svensson classification. The Penn classification recommends that the choice of management can be based on the extent of aortic dissection, the site of the primary intimal tear, and the presence of malperfusion. The latest TEM classification identifies type A and type B dissection, as well as additional non-A-non-B type, in which the descending aorta and the arch, but not the ascending aorta, are involved. The most appropriate surgical procedures for the retrograde type A aortic dissection treatment are discussed as well. Conclusions. 1. The purpose of clinical classification of acute aortic dissection is, in addition to systematizing concepts and categories, facilitating the selection of an optimal state-of-the-art treatment method. 2. Introducing such classifications as Penn or TEM will bring to a common denominator the results of surgical management of acute type A dissection by unifying the characteristics of the patients and eliminating their deliberate or accidental pre-selection, which possibly accounts for the difference in mortality rates among different surgical groups.

scholarly journals Visceral hybrid reconstruction of thoracoabdominal aortic aneurysm after open repair of type a aortic dissection by the Bentall procedure with the elephant trunk technique: A case report

2014 ◽  
Vol 71 (9) ◽  
pp. 879-883 ◽  
Author(s):  
Ivan Marjanovic ◽  
Momir Sarac ◽  
Aleksandar Tomic ◽  
Sinisa Rusovic ◽  
Leposava Sekulovic ◽  
...  
Keyword(s):  
Aortic Aneurysm ◽  
Aortic Dissection ◽  
Type A ◽  
Acute Type ◽  
Type B ◽  
Elephant Trunk ◽  
Type A Aortic Dissection ◽  
Bentall Procedure ◽  
Type B Dissection ◽  
Elephant Trunk Technique

Introduction. Reconstruction of chronic type B dissection and thoracoabdominal aortic aneurysm (TAAA) remaining after the emergency reconstruction of the ascending thoracic aorta and aortic arch for acute type A dissection represents one of the major surgical challenges. Complications of chronic type B dissection are aneurysmal formation and rupture of an aortic aneurysm with a high mortality rate. We presented a case of visceral hybrid reconstruction of TAAA secondary to chronic dissection type B after the Bentall procedure with the elephant trunk technique due to acute type A aortic dissection in a high-risk patient. Case report. A 62 year-old woman was admitted to our institution for reconstruction of Crawford type I TAAA secondary to chronic dissection. The patient had had an acute type A aortic dissection 3 years before and undergone reconstruction by the Bentall procedure with the elephant trunk technique with valve replacement. On admission the patient had coronary artery disease (myocardial infarction, two times in the past 3 years), congestive heart disease with ejection fraction of 25% and chronic obstructive pulmonary disease. On computed tomography (CT) of the aorta TAAA was revealed with a maximum diameter of 93 mm in the descending thoracic aorta secondary to chronic dissection. All the visceral arteries originated from the true lumen with exception of the celiac artery (CA), and the end of chronic dissection was below the origin of the superior mesenteric artery (SMA). The patient was operated on using surgical visceral reconstruction of the SMA, CA and the right renal artery (RRA) as the first procedure. Postoperative course was without complications. Endovascular TAAA reconstruction was performed as the second procedure one month later, when the elephant trunk was used as the proximal landing zone for the endograft, and distal landing zone was the level of origin of the RRA. Postoperatively, the patient had no neurological deficit and renal, liver function and functions of the other abdominal organs were normal. Control CT after 6 months showed full exclusion of the aneurysm from the systemic circulation without endoleak and good flow through visceral anastomosis. Conclusion. In patients with comorbidities, like in the presented case, visceral hybrid reconstruction of chronic dissection type B with TAAA could be the treatment of choice.

scholarly journals Anatomy of the retrograde type A aortic dissection after endovascular repair of type B aortic dissection: a case report

2021 ◽  
Vol 0 (Ahead of Print) ◽  
Author(s):  
Uliana Pidvalna ◽  
Marianna Mirchuk ◽  
Anna Voitovych ◽  
Dmytro Beshley
Keyword(s):  
Aortic Dissection ◽  
Aortic Arch ◽  
Type A ◽  
Ascending Aorta ◽  
Medical Attention ◽  
Acute Type ◽  
Type B ◽  
Type B Aortic Dissection ◽  
Type A Aortic Dissection ◽  
Aortic Replacement

Aortic dissection requires immediate medical attention. The optimal treatment approach of Type B aortic dissection is still a matter of debate. Possible options include open surgery, endovascular aortic repair (EVAR), and hybrid procedure. The indication for surgery is the dissection that involves the ascending aorta and the aortic arch (Type A Stanford, Types I and II DeBakey). Hybrid or endovascular procedures seem to be an attractive alternative treatment for patients with the complex aortic disease and a high risk of surgery. Endovascular treatment of acute Type B aortic dissections is designed to prevent the retrograde dissection of the ascending aorta and the aortic arch. The occurrence of retrograde Type A aortic dissection (RTAD) is rare, but the mortality rate is high. We report a case of a 55-year-old gentleman who had undergone thoracic EVAR. Thirty months after the given procedure he presented with RTAD and underwent supracoronary aortic replacement. The article is intended to remind the clinicians of the importance of early detection of the possible complications when performing EVAR, and the significance of a rapid response.

Abstract 4274: Retrograde Ascending Aortic Dissection During or After Thoracic Aortic Stent-Graft Placement- Insights from the European Registry on EVAR Complications (EUREC)

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Holger Eggebrecht ◽  
Matt Thompson ◽  
Herve Rousseau ◽  
Martin Czerny ◽  
Lars Lönn
Keyword(s):  
Aortic Dissection ◽  
Stent Graft ◽  
Direct Evidence ◽  
Acute Chest Pain ◽  
Aortic Disease ◽  
Acute Type ◽  
Type B ◽  
Stent Grafts ◽  
Type B Dissection ◽  
European Registry

Background: Thoracic endovascular aortic repair (TEVAR) is increasingly applied in the treatment of aortic dissections and aneurysms. Single center reports have addressed retrograde ascending aortic dissection (rAAD) as a potentially lethal complication unique to TEVAR. We used data from a European multi-center registry to determine possible etiological factors and outcomes of this dreadful complication. Methods: So far 15 European sites and 1 Chinese center are contributing to the European Registry on EVAR Complications (EUREC) which is an open, independent, ongoing multi-center registry. Between 01/1998 and 05/2008 these centers performed a total of 3074 TEVAR procedures. Results: 33 rAAD cases (56.3±11.6 yrs, 20 males) were reported (incidence 1.1%). Indications for TEVAR were: acute type B dissection (n=17), chronic dissection (n=10), thoracic aneurysm (n=4), and aortic ulcer (n=1). 20 procedures were performed as emergency TEVAR. Stent-grafts with proximal bare springs were used in 26/33 (79%) cases. Additional balloon inflations were performed in 6 (18%) cases. rAAD occurred intraoperatively (n=5, 15%), during the index hospitalization (n=7, 21%), and during follow-up (n=21, 64%). 9 (27%) patients were asymptomatic, the remaining patients presented with acute chest pain (n=11, 33%), syncope (n=10, 30%), or sudden death (n=5, 15%). Emergency or elective surgical repair was performed in 19 and 4 patients, respectively. Conservative therapy was chosen in the remaining 10 patients. Outcome was fatal in 14/33 (42%) patients. The most probable cause of rAAD as reported by the investigators was stent-graft induced in 58%, procedure related in 9%, and underlying undiagnosed aortic disease in 15% of patients. In 16/33 patients direct evidence of stent-graft induced rAAD was obtained by surgery or necropsy. Conclusion: Although the incidence of rAAD was low (1.1%) in the present EUREC analysis, it was associated with significant mortality (42%). Patients undergoing TEVAR for type B dissection appeared to be most prone rAAD. As suspected, the majority of rAAD cases was associated with the use of proximal bare spring stent-grafts and in almost half of the patients direct evidence of stent-graft induced injury was obtained from surgery or necropsy.

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