Project description:ObjectivesA low false lumen thrombosis rate (FLTR) is common in patients with type B aortic dissection after they have undergone thoracic endovascular aortic repair, which indicates a poor long-term prognosis. This study aimed to establish a quantitative linear regression model to predict false lumen (FL) thrombosis accurately using morphological parameters.MethodsIn this retrospective study, we included 59 patients diagnosed with acute type B aortic dissection between 2014 and 2017. Morphological parameters were measured. Univariable and multivariable linear regression analyses were performed, and a linear regression model relating FLTR with the number of re-entry tears was proposed. Ten patients were further chosen to validate the linear relationship, and idealized aortic dissection models were adopted for haemodynamic analysis.ResultsOnly the total area and number of re-entry tears were negatively correlated with FL thrombosis (P < 0.001). Moreover, based on the univariable regression, the number of re-entry tears played a more crucial role in FLTR (R2 = 0.509 vs R2 = 0.298), and the linear relationship model was created as follows: thrombosis rate (%) = -11.25 × distal tear number + 105.24. This model was perfectly matched in 10 patients (concordance correlation coefficient = 0.880, P = 0.947). Moreover, when the total area of re-entry tears was constant, the net blood flow increased rapidly with an increase in the tear count.ConclusionsThe number of re-entry tears could be a crucial related factor of FL thrombosis; the larger the number of re-entry tears is, the lower the possibility of thrombosis is.
Project description:BackgroundThoracic endovascular aortic repair (TEVAR) has become a widely accepted treatment strategy for patients with thoracic aortic pathologies. We present a case of TEVAR where transesophageal echocardiography (TEE) played a crucial role for adequate placement of an endovascular stent graft.Case presentationA 71-year-old male received TEVAR for type B aortic dissection. TEE detected both true/false lumens with an intimal tear. A guidewire was inserted into the descending aorta via the left femoral artery; however, angiography failed to identify the precise location of the tip of the guidewire. TEE detected the guide wire passing through the intimal tear into the false lumen, promoted the surgeon to manipulate and advance it to the true lumen, followed by placement of a stent graft. The patient was hemodynamically stable through the whole procedure.ConclusionTEE was crucially important for detecting the precise location of the guidewire and preventing complications during TEVAR.
Project description:Thoracic endovascular aortic repair has become the preferred modality of treatment of complicated type B aortic dissections. However, persistent pressurization of the false lumen can lead to negative aortic remodeling with aneurysmal dilation. Described herein is the coil embolization technique that can be used to manage this complication and a review of the literature on the recent development of management options.
Project description:ObjectiveRetrograde false lumen perfusion has limited the utility of aortic stent grafting for chronic aortic dissection. It is unknown whether balloon septal rupture can improve the outcomes for endovascular management of chronic aortic dissection.MethodsIncluded patients underwent false lumen obliteration and creation of a single-lumen aortic landing zone using balloon aortoplasty during thoracic endovascular aortic repair. The distal thoracic stent graft was sized to the total aortic lumen diameter, and septal rupture was performed within the stent graft with a compliant balloon in the region 5 cm proximal to the distal fabric edge. Clinical and radiographic outcomes are reported.ResultsForty patients, with an average age 56 years, underwent thoracic endovascular aortic repair with septal rupture. Seventeen patients (43%) had chronic type B dissections, 17 of 40 patients (43%) had residual type A dissections, and 6 of 40 patients (15%) had acute type B dissections. Nine cases were emergency, complicated by rupture or malperfusion. Perioperative complications included 1 death (2.5%) due to rupture of the descending thoracic aorta and 2 (5%) instances each of stroke (neither permanent) and spinal cord ischemia (1 permanent). Two (5%) stent graft-induced new injuries were seen. Average postoperative computed tomography follow-up was 1.4 years. Thirteen patients (33%) had a decrease in aortic size, 25 of 39 patients (64%) were stable, and 1 of 39 patients (2.6%) had an increased aortic size. Partial and complete false lumen thrombosis were achieved in 10 of 39 patients (26%) and 29 of 39 patients (74%), respectively. Midterm aortic-related survival was 97.5% at an average of 1.6 years.ConclusionsControlled balloon septal rupture offers an effective endovascular method to treat aortic dissection in the distal thoracic aorta.
Project description:Degenerative aneurysms of the thoracic aorta are increasing in prevalence; open repair of descending thoracic aortic aneurysms is associated with high rates of morbidity and mortality. Repair of isolated descending thoracic aortic aneurysms using stent grafts was introduced in 1995, and in an anatomically suitable subgroup of patients with thoracic aortic aneurysm, repair with endovascular stent graft provides favorable outcomes, with decreased perioperative morbidity and mortality relative to open repair. The cornerstones of successful thoracic endovascular aneurysm repair are appropriate patient selection, thorough preprocedural planning, and cautious procedural execution, the elements of which are discussed here.
Project description:ObjectivesIn uncomplicated type B aortic dissection, a large false lumen (FL) is reportedly a risk factor for late aortic events. However, it is unclear how the relationship between the false and true lumen (TL) diameters affects the dissected aorta. This study aimed to evaluate the impact on clinical outcomes of the FL being larger than the TL.MethodsWe retrospectively reviewed 111 consecutive patients with uncomplicated acute type B aortic dissection between 2004 and 2018. We divided the patients into group A (FL > TL; n = 51) and group B (FL ≤ TL; n = 60), and compared the outcomes. The endpoints were aortic events, including surgery for aortic dissection and indication for surgery, and mortality.ResultsThe 5-year incidence rates of aortic events were 68.4% in Group A and 33.6% in Group B (P = 0.002). The 5-year all-cause mortality rates were 5.3% in Group A and 21.9% in Group B (P = 0.003). The multivariable analyses revealed that FL > TL was an independent factor associated with aortic events (adjusted hazard ratio 2.482, 95% confidence interval 1.467-4.198, P < 0.001), but had low mortality (adjusted hazard ratio 0.209, 95% confidence interval 0.073-0.597, P = 0.003).ConclusionsPatients with uncomplicated type B aortic dissection with FL > TL at admission are at increased risk of aortic events but improve mortality compared to patients with FL ≤ TL.Clinical trial registrationUMIN000036997.