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1
Galyautdinova, L. E., I. V. Basek, D. V. Karpova, M. A. Chernyavskiy, V. S. Yegorova, and A. A. Borshevetskaya. "Diagnostic imaging for DeBakey type III aortic dissection complicated by aneurysm rupture with the formation of an aortoesophageal fistula: a case report." Translational Medicine 10, no. 1 (2023): 36–45. http://dx.doi.org/10.18705/2311-4495-2023-10-1-36-45.
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Aortic dissection is a type of acute aortic syndrome characterized by a high mortality rate in the first 48 hours. The problem of early diagnosis of acute aortic dissection is still relevant and due to a high risk of severe complications, as well as a non-specific clinical features. If left untreated, aortic dissection can be complicated by the formation of an aortic aneurysm and its rupture. Sometimes, the rupture of an aortic aneurysm is accompanied by the fistula formation. The article discusses the use of computed tomography (CT) scans for visualization of DeBakey type III aortic dissection complicated by aortic rupture and the formation of an aorto-esophageal fistula.A 60 y.o. male diagnosed with aortic dissection was urgently transferred from the city hospital for surgical treatment. As part of the preoperative preparation, the patient underwent computed tomography angiography (CT angiography), that demonstrated not only an acute DeBakey type III dissection with a thoracic aortic aneurysm of the descending aorta, but also its complication in the form of aortic rupture with the formation of aorto-esophageal fistula.The patient underwent a successful endovascular thoracic aortic stent grafting with unmarkable postoperative period. Follow-up CT angiography showed complete isolation of the false lumen and closure of the aorto-esophageal fistula. The patient showed clinical improvement and was discharged home on 14 day.
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Ratna, Sumol, Vipin Choudhary, Simran Gangwani, Vinita Chauhan, and Vijay Mohane. "AORTIC DISSECTION MISDIAGNOSED AS A HYPERTENSIVE CRISIS: A CASE REPORT." International Journal of Advanced Research 11, no. 11 (2023): 1251–55. http://dx.doi.org/10.21474/ijar01/17936.
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Acute aortic dissection is an uncommon disorder which can have fatal results in the event of treatment delay or misdiagnosis. This case examines a 61-year-old woman presenting with hypertension initially diagnosed as hypertensive crises relieved by antihypertensive medication. She was referred to the cardiology with clinical suspicion of acute coronary syndrome (ACS). However, she was later diagnosed with acute aortic dissection by CT-angiography and sent to surgical unit. Aortic dissection patient presents with many non-specific complaints so mostly misdiagnosed. This case report of a 61-years-old female with diagnosis of Stanford Type A acute aortic dissection misdiagnosed as a hypertensive crisis aiming towards highlighting this potentially fatal condition and importance of early diagnosis The early assessment and early CT-angiography can help in reaching the diagnosis so that early and accurate intervention can be done to save the life of patient from this fatal disease.
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Wan Ab Naim, Wan Naimah, Poo Balan Ganesan, Zhonghua Sun, Kok Han Chee, Shahrul Amry Hashim, and Einly Lim. "A Perspective Review on Numerical Simulations of Hemodynamics in Aortic Dissection." Scientific World Journal 2014 (2014): 1–12. http://dx.doi.org/10.1155/2014/652520.
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Aortic dissection, characterized by separation of the layers of the aortic wall, poses a significant challenge for clinicians. While type A aortic dissection patients are normally managed using surgical treatment, optimal treatment strategy for type B aortic dissection remains controversial and requires further evaluation. Although aortic diameter measured by CT angiography has been clinically used as a guideline to predict dilation in aortic dissection, hemodynamic parameters (e.g., pressure and wall shear stress), geometrical factors, and composition of the aorta wall are known to substantially affect disease progression. Due to the limitations of cardiac imaging modalities, numerical simulations have been widely used for the prediction of disease progression and therapeutic outcomes, by providing detailed insights into the hemodynamics. This paper presents a comprehensive review of the existing numerical models developed to investigate reasons behind tear initiation and progression, as well as the effectiveness of various treatment strategies, particularly the stent graft treatment.
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Memon, Waqas, Zobia Aijaz, and Rmaah Memon. "Paraplegia and acute aortic dissection: a diagnostic challenge for physicians in the emergency situation." BMJ Case Reports 12, no. 7 (2019): e230561. http://dx.doi.org/10.1136/bcr-2019-230561.
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Acute aortic dissection presenting neurological symptoms is rare and entails significant diagnostic challenges. We present a case of 45-year-old woman with a medical history of essential hypertension and smoking, admitted with lobar pneumonia. During her inpatient treatment, she developed severe back pain and numbness below the level of the umbilicus. Due to her presenting symptoms considered differential diagnoses were paravertebral abscess and acute stroke. CT scan of the head did not reveal any ischaemic changes. Further investigation with MRI (with and without contrast) raised concerns for possible aortic dissection. CT angiography of thorax, abdomen and pelvis displayed extensive aortic dissection extending from aortic root to left iliac artery limiting flow to right carotid artery causing stenosis. The patient was diagnosed with Stanford type A aortic dissection. The patient was referred to the cardiothoracic surgery team for surgical repair. The patient made a good recovery after a prolonged course of hospitalisation, followed by cardiac rehabilitation and physical therapy.
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Carroll, Brett J., Marc L. Schermerhorn, and Warren J. Manning. "Imaging for acute aortic syndromes." Heart 106, no. 3 (2019): 182–89. http://dx.doi.org/10.1136/heartjnl-2019-314897.
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Acute aortic syndromes (AAS) represent a spectrum of disorders with a common theme of disruption in aortic integrity. AAS are associated with high morbidity and mortality and warrant emergent medical or surgical intervention as delayed treatment is associated with worse outcomes. There are multiple advanced imaging modalities for the diagnosis and complimentary assessment of AAS, each with advantages and limitations. CT angiography remains the imaging modality of choice for diagnosis in the overwhelming majority of patients as it is rapidly acquired and widely available; however, transoesophageal echocardiogram also offers excellent diagnostic accuracy in addition to complimentary data for surgical repair in those with type A dissection. Transthoracic echocardiography and magnetic resonance angiography can also be valuable in select patients. Imaging is increasingly important for risk stratification in the subacute and chronic phases of AAS. Additionally, imaging is vital for planning of interventions in both acute and delayed intervention. Endovascular treatment options are used with increasing frequency—multimodality imaging during the procedure allows for optimisation of these increasingly complex procedures.
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Bilbija, Ilija, Milos Velinovic, Mile Vranes, Petar Djukic, Dragutin Savic, and Svetozar Putnik. "Ascending aorta false aneurysm as a late complication of aortic valve surgery." Srpski arhiv za celokupno lekarstvo 140, no. 11-12 (2012): 765–67. http://dx.doi.org/10.2298/sarh1212765b.
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Introduction. False aneurysms of the ascending aorta represent a rare but potentially fatal complication of cardiac surgical procedures. Predisposing factors are aortic dissection, infection, connective tissue disorders, chronic hypertension, aortic calcifications and aortotomy dehiscence. At the beginning they are usually asymptomatic, but later various symptoms arise as a consequence of vital structures compression. Potential risk of rupture rises with time and pseudoaneurysm enlargement. From surgical point of view treatment of such cases represents a unique challenge because of the great danger of inadvertent opening of the aneurysm during resternotomy. Case Outline. A 58-year-old female patient underwent aortic valve replacement due to severe aortic stenosis in 2004. Operation and postoperative recovery were uneventful. Three years later she started complaining about chest pain. On chest X-ray there was upper mediastinal widening. CT scan showed a pseudoaneurysm of the ascending aorta located in front of the right atrium and right ventricle, which was subsequently verified by angiography. During redo operation the pseudoaneurysm was successfully resected and aorta closed with separate ethybond sutures with pledgets. Conclusion. Postoperative pseudoaneurysms of the ascending aorta mostly arise from the suture lines. The most useful diagnostic procedures are contrast CT scan, echocardiography, angiography and MRI. Surgical intervention is absolutely indicated. The institution of cardiopulmonary bypass by alternative ways before chest opening is strongly recommended.
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Zhekov, Ihor I., Vitalii I. Kravchenko, Oleh I. Sarhosh, Olena B. Larionova, and Anatoliy V. Rudenko. "Results of Treatment of Patients with Concomitant Aortic Lesions and Coronary Heart Disease." Ukrainian Journal of Cardiovascular Surgery 30, no. 1 (46) (2022): 27–31. http://dx.doi.org/10.30702/ujcvs/22.30(01)/zhk007-2731.
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The aim. To determine the degree of increased operative risk in the group of patients with a combination of aortic aneurysms and coronary artery disease compared with those with isolated aortic aneurysms.
 Materials and methods. In the period from January 1, 2010 to October 1, 2021 at the National Amosov Institute of Cardiovascular Surgery, 820 patients with aortic aneurysm, including 172 (20.9%) patients with concomitant aortic and coronary artery disease, underwent surgical treatment. Diagnosis was based on standard examination methods such as electrocardiography, transthoracic echocardiography, coronary angiography, and computed tomography without coronary angiography in cases of aortic dissection. In patients with aortic dissection and coronary artery disease, the extent of the lesion was examined mainly by CT diagnosis and Coronary Artery Disease Reporting and Data System (CAD-RADS) scale due to contraindications to coronary angiography.
 Results.Thetotalnumberofcomplicationswas26(15.1%)cases.Cerebrovasculardisorderswereobservedin4(2.3%) cases, 3 of which regressed in the postoperative period; in all 4 (2.3%) cases there was a history of acute cerebrovascular disorders. Spinal cord ischemia was observed in 2 (1.2%) cases. Multiple organ failure occurred in the postoperative period in 6 (3.5%) patients, renal failure in 4 (2.3%) patients. Respiratory failure was found in 3 (1.7%) patients. Septic shock occurred in 1 (0.6%) patient. Increased exudation was present in 6 (3.5%) cases requiring rethoracotomy. There were 7 (4.0%) in-hospital deaths, 3 (9.3%) in the acute dissection group and 4 (2.9%) in the aortic aneurysm group without stratification. The distribution of patients by lethal complications was as follows: 1 (14.3%) patient had acute cerebrovascular accident, 1 (14.3%) had septic shock and 1 (14.3%) had acute renal failure. In more than 50% of cases, the cause of death was multiple organ failure (4 [57%] patients).
 Conclusions. Concomitant lesions of arteries with aortic aneurysms are associated with higher rates of postoperative complications and mortality. In the group of patients with aortic dissection combined with coronary artery disease, there was longer duration of surgery, duration of artificial circulation and aortic compression due to the high initial severity of condition in such patients and greater complexity and volume of surgery. Hospital mortality in the group of aortic aneurysms combined with coronary artery lesions was almost 3 times higher than that in the group of isolated aortic aneurysms (4% and 1.5%, respectively).
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Deniz, Turgut, Ersel Dag, Murat Tulmac, Burcu Azapoglu, and Caglar Alp. "What Lies behind the Ischemic Stroke: Aortic Dissection?" Case Reports in Emergency Medicine 2014 (2014): 1–4. http://dx.doi.org/10.1155/2014/468295.
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Introduction. Some cases with aortic dissection (AD) could present with various complaints other than pain, especially neurological and cardiovascular manifestations. AD involving the carotid arteries could be associated with many clinical presentations, ranging from stroke to nonspecific headache.Case Report. A 71-year-old woman was admitted to emergency department with vertigo which started within the previous one hour and progressed with deterioration of consciousness following speech disorder. On arrival, she was disoriented and uncooperative. Diffusion magnetic resonance imaging (MRI) of brain was consistent with acute ischemia in the cerebral hemisphere. Fibrinolytic treatment has been planned since symptoms started within two hours. Echocardiography has shown the dilatation of ascending aorta with a suspicion of flap. Computed tomography (CT) angiography has been applied and intimal flap has been detected which was consistent with aortic dissection, intramural hematoma of which was reaching from aortic arch to bilateral common carotid artery. Thereafter, treatment strategy has completely changed and surgical invention has been done.Conclusion. In patients who are admitted to the emergency department with the loss of consciousness and stroke, inadequacy of anamnesis and carotid artery involvement of aortic dissection should be kept in mind.
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von Bierbrauer, Dilger, and Fink. "Acute aortic dissection – vascular emergency with numerous pitfalls." Vasa 37, no. 1 (2008): 53–59. http://dx.doi.org/10.1024/0301-1526.37.1.53.
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Acute aortic syndrome comprises acute aortic dissection, aortic intramural haematoma and penetrating atherosclerotic ulcers of the aortic wall. It ranks, after acute coronary syndrome, as one of the most frequent acute life-threatening differential diagnoses of chest pain. Chances of survival would probably be good in the large majority of cases, assuming optimal therapeutic management including rapid diagnostic evaluation followed by immediate and appropriate treatment is provided. However, actual mortality rate in these patients is still currently higher than 40%, despite medical and surgical progress. This unfavourable prognosis for the most frequent variant of acute aortic syndrome – aortic dissection – is due to the wide variability of clinical symptoms. These are often initially unspecific and frequently lead to delays in establishing the correct diagnosis, possibly first recognised at autopsy. Even after a timely, correct diagnosis, there is still a considerably high mortality rate following surgery, even with younger patients. Whenever acute aortic dissection is suspected a diagnostic imaging study should immediately be obtained. In addition to CT angiography, transesophageal echocardiography is recommended, due to its flexibility, as the diagnostically most useful tool in this context. Based on three case reports of acute aortic dissection this paper critically discusses the problems in making a correct and timely diagnosis and also provides an overview of the current state of knowledge in the areas of pathophysiology, epidemiology, clinical symptomatology as well as appropriate case-related management and prognosis of acute aortic dissection.
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Kong, Jinhu, Jiazheng Li, Haiyang Hu, Shangyun Pan, and Hongsheng Liu. "DeBakey Type III Aortic Dissection Causing Bowel Necrosis: A Case Report." Journal of Clinical and Nursing Research 8, no. 8 (2024): 159–62. http://dx.doi.org/10.26689/jcnr.v8i8.8204.
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Rationale: Aortic dissection is a life-threatening medical emergency associated with high morbidity and mortality. Preoperative mesenteric malperfusion increases the surgical risk and mortality in patients with type B aortic dissection. For DeBakey type III B patients involving most of the thoracoabdominal aorta, endovascular treatment to improve true lumen perfusion may have limited benefits. Organ reperfusion on-time is crucial. Patient concerns: A 38-year-old man was admitted with sudden severe upper abdominal pain. Emergency CTA of the entire aorta revealed an aortic dissection with an entry tear in the descending aortic arch involving the celiac trunk, superior mesenteric artery, bilateral common iliac arteries and right external iliac artery, with thrombosis in the superior mesenteric artery. Diagnoses: The patient was diagnosed with DeBakey type III aortic dissection with mesenteric artery embolism. Enhanced chest CT showed the entry tear location and involvement of major arteries. Angiography confirmed partial blood flow in the superior mesenteric artery. Interventions: The patient underwent endovascular aortic stent-graft implantation through the left femoral artery, covering the descending aortic arch and sealing the entry tear. Postoperatively, the patient received intensive care, including ventilatory support, CRRT, anti-infection therapy, vasoactive drugs and lumbar cistern drainage. Outcomes: Two weeks postoperatively, the patient developed massive black stools, indicative of intestinal obstruction and necrosis. Exploratory laparotomy revealed ischemic necrosis and rupture of the stomach, small intestine, and colon. Despite surgical efforts, the patient’s condition deteriorated, leading to death from severe infection, acid-base imbalance and multiple organ failure.
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Sarhosh, Oleh I., Vitalii I. Kravchenko, Ihor I. Zhekov, Ivan M. Kravchenko, and Oleksandr M. Dovgan. "Experience in the Management of Patients with Acute Type A Aortic Dissection and Coronary Ostial Involvement Classified as Neri Type B." Ukrainian Journal of Cardiovascular Surgery 33, no. 1 (2025): 98–102. https://doi.org/10.63181/ujcvs.2025.33(1).98-102.
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Introduction. Acute type A aortic dissection (ATAAD) is a life-threatening condition with a high mortality rate, particularly in the absence of surgical intervention. Coronary artery involvement in ATAAD occurs in 7–20.7% of patients and is associated with a poor prognosis. Despite various surgical approaches, the optimal treatment strategy remains controversial, especially in cases of type B coronary ostial dissection according to the Neri classification. Aim. To analyze the outcomes of coronary ostia repair in patients with acute type A aortic dissection (ATAAD) involving coronary artery ostia classified as type B by Neri. Materials and methods. Between 2019 and 2023, 316 patients with ATAAD underwent surgery at the National Institute of Cardiovascular Surgery named after M.M. Amosov. Among them, 49 (15.5%) had coronary artery ostia involvement, and 21 patients (42.9%) were classified as Neri type B. Preoperative assessment was performed using CT and, in selected cases, coronary angiography, which was confirmed intraoperatively. The primary surgical approach involved supracoronary ascending aortic replacement with partial arch repair. Results. Coronary ostia repair was performed in all patients in this cohort. In 14.3% of cases, extended patch repair using autopericardium was required. Supracoronary ascending aortic replacement was carried out in 90.5% of patients, while the Bentall procedure was necessary in 9.5%. The in-hospital mortality rate was 9.5%. Major postoperative complications included acute renal failure (9.5%), ischemic brain injury (9.5%), and spinal cord ischemia (4.8%). Conclusions. Coronary ostia repair is an effective approach for treating coronary involvement in ATAAD patients with Neri type B dissection. However, the high rate of complications and mortality highlights the need for further refinement of surgical techniques and more accurate preoperative diagnostic methods.
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Rubbert-Roth, A., P. K. Bode, T. Langenegger, et al. "THU0319 DEVELOPMENT AND OUTCOME OF AORTIC COMPLICATIONS DURING TOCILIZUMAB TREATMENT OF GCA AND HISTOPATHOLOGIC EVIDENCE OF RESIDUAL INFLAMMATION-A CASE SERIES." Annals of the Rheumatic Diseases 79, Suppl 1 (2020): 388.2–389. http://dx.doi.org/10.1136/annrheumdis-2020-eular.4660.
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Background:Giant cell arteritis (GCA) may affect the aorta and the large aortic branches and lead to dissections and aortic aneurysms. Tocilizumab (TCZ) treatment has the capacity to control aortic inflammation as has been demonstrated by CRP normalization and imaging data. However, limited data are available on the histopathological findings obtained from patients who underwent surgery because of aortic complications during TCZ treatment.Objectives:We report on 5 patients with aortitis who were treated with TCZ and developed aortic complications.Methods:We describe a retrospective case series of patients with GCA treated with TCZ, who presented in our clinic between 2011 and 2019. Three patients underwent surgery. Histopathologic examination was performed in specimen from all of them.Results:Five female patients were diagnosed with GCA (4/5) or Takaysu arteritis (1/5) involving the aorta, all them diagnosed by MR angiography and/or FDG PET CT scan. Three patients (one with aortic aneurysm, one with dissection) underwent surgery after having been treated with TCZ for seven weeks, nine months and four years, respectively. Imaging before surgery showed remission on MRI and/or PET-CT in all cases. At the time of surgery, all patients showed normalized CRP and ESR values. Histopathological evaluation of the aortic wall revealed infiltrates, consisting predominantly of CD3+CD4+ T cells. Enlargement of pre-existing aneuryms was observed in the other two patients 10 weeks and 4 months after discontinuation of TCZ, respectively. Both patients were not eligible for surgical intervention and died during follow-up.Conclusion:Our case series suggests that during treatment with TCZ, regular imaging is necessary in this patient population to detect development of structural changes such as aneurysms or dissections. Despite treatment, residual inflammation might persist which could contribute to eventual aortic complications.Disclosure of Interests:Andrea Rubbert-Roth Consultant of: Abbvie, BMS, Chugai, Pfizer, Roche, Janssen, Lilly, Sanofi, Amgen, Novartis, Peter Karl Bode: None declared, Thomas Langenegger: None declared, Claudia Pfofe: None declared, Thomas Neumann: None declared, Olaf Chan-Hi Kim: None declared, Johannes von Kempis Consultant of: Roche
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Eremia, Irina-Anca, Mihnea-Ioan-Gabriel Popa, Cătălin-Alexandru Anghel, et al. "Outcomes of Surgical Versus Conservative Management in Stanford Type a Aortic Dissection: A Single-Center Retrospective Study." Life 15, no. 3 (2025): 462. https://doi.org/10.3390/life15030462.
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Acute aortic dissection (AAD) is a critical cardiovascular emergency marked by the rupture of the aortic intima, resulting in blood infiltration into the media and the formation of a false lumen. AAD incidence varies by area, emphasizing the need for better diagnostics and epidemiological investigations. Bucharest University Emergency Hospital’s Emergency Department conducted this retrospective cohort analysis from May 2021 to May 2023. We examined 26 Stanford Type A aortic dissection patients to establish in-hospital mortality and one-year survival rates. The primary objective was to analyze demographic, clinical, and paraclinical factors and their impact on patient outcomes. A total of 57.7% of the study group was male and had a mean age of 58.2 years, and 69.2% of patients had hypertension, indicating its importance as a risk factor. Acute chest discomfort was reported by 53.8%, neurological problems by 30.8%, and syncope or hypotension by 42.3%. CT angiography and transthoracic echocardiogram (TTE) confirmed the diagnosis and assessed dissection severity. Pericardial effusion (19.2%) and moderate to severe aortic regurgitation (26.9%) were notable. Management varied by dissection intensity and location. Emergency surgery was performed in 61.5% of patients within 24 h of diagnosis, resulting in a 12.5% in-hospital death rate. Conservatively managed patients had a 60.0% in-hospital death rate. Timely intervention is crucial, since the surgical cohort had an 87.5% one-year survival rate compared to 30% for the conservatively managed cohort. Acute renal damage (25%), protracted mechanical ventilation (31.3%), and advanced supportive care infections were postoperative sequelae. Conservative care exacerbated visceral ischemia (20%) and heart failure (10%). Advanced age and hypotension upon admission were independent mortality predictors, emphasizing the need for early risk assessment and personalized treatment. Multimodal imaging, timely surgical referral, and excellent postoperative care improve AAD outcomes, according to this study.
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Fernández-Alonso, Leopoldo, Sebastián Fernández Alonso, Esther Martínez Aguilar, et al. "Endovascular Treatment of Aortic Arch Lesions Using Scalloped Endografts." Vascular and Endovascular Surgery 52, no. 1 (2017): 22–26. http://dx.doi.org/10.1177/1538574417740056.
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Objective: To present our early and midterm results using thoracic endovascular aortic repair (TEVAR) with a custom-made proximal scalloped stent graft to accommodate left common carotid artery (LCCA) and innominate artery (IA) in treating aortic lesions involving the arch. Materials and Methods: Between February 2014 and April 2017, select patients presenting with aortic arch lesions and short proximal landing zone were treated by proximal scalloped Relay Plus stent grafts. Patient demographics, operative details, clinical outcomes, and complications were analyzed. Results: Six patients (50% male) with a median age of 71 years (range, 60-82) underwent scalloped TEVAR using thoracic custom-made Relay Plus stent graft to preserve flow in the proximal supra-aortic trunks. Target vessels for the scallop were LCCA in 5 cases and IA in 1 case. The technical success rate was 100%, and proximal seal was achieved in all cases with no type I endoleaks on completion angiography. The median follow-up period was 20 (7-32) months. No conversion to open surgical repair and no aortic rupture occurred. One patient had a distal type I endoleak on the 6-month computed tomography (CT) scan, and 1 patient had a proximal type I endoleak on the 12-month CT scan. There was no stroke, paraplegia, retrograde type A dissection, or other aortic-related complication. We routinely used temporary rapid right ventricular pacing to obtain a near-zero blood pressure level during the graft deployment. No complications were observed related to the use of rapid pacing. Conclusion: When anatomy allows, proximal scalloped stent graft to accommodate LCCA and IA is a viable therapeutic option in treating aortic lesions involving the arch with short proximal landing zones. In addition, these findings represent a strong argument for the use of temporary rapid pacing during graft deployment.
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ZHAO, Shao-hong, Laura Logan, Pamela Schraedley, and Geoffrey D. Rubin. "Assessment of the anterior spinal artery and the artery of Adamkiewicz using multi-detector CT angiography." Chinese Medical Journal 122, no. 2 (2009): 145–49. http://dx.doi.org/10.3760/cma.j.issn.0366-6999.2009.02.006.
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Background Damage to the spinal cord after the treatment of the descending thoracic and thoracoabdominal aortic aneurysms is an uncommon but devastating complication. The artery of Adamkiewicz (AKA) is the principal arterial supply of the anterior spinal artery (ASA) in the lower thoracic and lumbar level. The purpose of this study was to evaluate the visualization of the anterior spinal artery and the artery of Adamkiewicz, the affecting factors for the detection rate using multi-detector row CT (MDCT). Methods Ninety-nine consecutive patients (31 women and 68 men; age range, 25-90 years; average age 61.3 years), with suspicion for thoracic aortic lesions necessitating surgical intervention (31 aortic aneurysm, 45 dissection, 5 intramural hematoma, and 18 normal), underwent CT angiography from the aortic arch to the aortic bifurcation. Transverse sections, multiplanar reformations and thin maximum intensity projections were used to assess the ASA and AKA. The level of the ASA and AKA origins and CT acquisition parameters were recorded. The contrast-to-noise ratio of the image, an index of the mass of the T11 body (vertebral mass index), the subcutaneous fat thickness, and the CT value within the aortic arch and at the T11 level were measured. The detection of the ASA and AKA were evaluated relative to the acquisition parameters, scan characteristics, and aortic lesion type. Differences were assessed with the Wilcoxon rank-sum and t tests. Results The ASA was visualized in 51 patients (52%) and the AKA in 18 patients (18%). The ASA was identified in 36/67 patients (54%) with 1.25 mm thickness and in 15/32 patients (47%) with 2.5-3.0 mm thickness. This difference did not achieve significance (P=0.13). The detection rate of the ASA and the AKA was influenced by the vertebral mass index and the contrast-to-noise ratio (P<0.05). The amount of subcutaneous fat affected the detection rate of the ASA (P <0.05) but not the AKA. In CT scans of ASA detection, the mean CT values in the aorta at the arch and at T11 were 360 and 358 HU, respectively, whereas in CT scans without ASA detection, the CT values in the aorta at the arch and at T11 were lower (P <0.05), 297 and 317 HU, respectively. Conclusions The ASA and AKA were less frequently detected in our cohort than previous reports. The visualization of the ASA and AKA was significantly affected by aortic enhancement, the “vertebral mass index”, and the contrast-to-noise ratio.
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Szeberin, Zoltán, Gábor Firneisz, Gábor Bíró, et al. "Surgical treatment of acute type B aortic dissection associated with use of cocaine." Orvosi Hetilap 150, no. 3 (2009): 129–31. http://dx.doi.org/10.1556/oh.2009.28541.
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A kokainfogyasztás gyakorisága Magyarországon is növekszik. E drog használata fokozott kockázatot jelent szív- és érrendszeri betegségek kialakulása, például aortadissectio szempontjából. Klinikánkon zajlik hazánkban a B típusú aortadissectiós betegek döntő többségének ellátása. Célkitűzés: Egy rendszeresen kokaint használó, akut B típusú aortadissectiót elszenvedett beteg műtéti kezelését mutatjuk be esetismertetésünkben, amely tudomásunk szerint az első hasonló eset hazánkban. Módszer: Esetleírás. Eredmények: Egy 35 éves férfi erős, mellkasi-háti-deréktáji fájdalmak miatt először a gerincsebészeti osztályhoz fordult, majd kiugróan magas vérnyomásértékek miatt belgyógyászati osztályra helyezték át. A B típusú aortadissectio diagnózisát CT-angiographia igazolta, a beteg érsebészeti centrumba került, ahol sikeres műtétet, thoracoabdominalis aortarefenesztrációt végeztünk. A beteg 3 hónappal a műtét után jól van, antihipertenzív szerek szedése mellett mindennapi feladatait ellátja, szövődményt nem észleltünk, a kokainról leszokott. Következtetések: Az akut B típusú dissectio sebészi ellátása megmentheti a beteg életét. A hosszú távú eredményes kezelésben a hipertónia kontrollja mellett a kokainról történő leszokás alapvető jelentőségű. Hasonló esetek előfordulására a kokainfogyasztás növekedése esetén hazánkban is számíthatunk.
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Guenther, Sabina P. W., Sven Peterss, Angela Reichelt, et al. "Diagnosis of coronary affection in patients with AADA and treatment of postcardiotomy myocardial failure using extracorporeal life support (ECLS)." Heart Surgery Forum 17, no. 5 (2014): 253. http://dx.doi.org/10.1532/hsf98.2014397.
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<p><b>Background:</b> Myocardial ischemia due to concomitant coronary artery disease (CAD) or coronary dissection in patients with acute aortic dissection type Stanford A (AADA) is associated with myocardial failure and poor outcomes. Preoperative coronary angiography in this group of patients is still debated. The use of CT scan to diagnose coronary affection along with the establishment of high-pitched dual-spiral CT protocols are essential for improving outcomes.</p><p><b>Methods:</b> We retrospectively analyzed six AADA patients with heart failure who were treated using extracorporeal life support (ECLS). Options for diagnosing coronary affection and different therapeutic strategies for postcardiotomy cardiogenic shock in this patient cohort are discussed.</p><p><b>Results:</b> Retrospective review of CT images showed coronary abnormalities in 83% (n = 5). Four patients (67%) underwent unplanned coronary artery bypass grafting (CABG). ECLS was instituted in 67% (n = 4) due to left heart failure and in 33% (n = 2) due to right heart failure. Thirty day mortality was 67% (n = 4). The two patients that received ECLS for right ventricular support survived and both had undergone CABG.</p><p><b>Conclusion:</b> Besides preoperative evaluation of the extent of the dissection, focus on coronary affection in CT-scans helps to triage the operative procedure. Hybrid operating rooms allow for immediate interventional and/or surgical treatment and enable for immediate control of revascularization results. The use of ECLS over other types of ventricular support systems may allow for myocardial recovery in selected cases.</p>
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Liguori, Carlo, Giulia Lassandro, Giovanni Ferrandino, et al. "ECG-Gated CCTA in the Assessment of Post-Procedural Complications." Diagnostics 13, no. 15 (2023): 2500. http://dx.doi.org/10.3390/diagnostics13152500.
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Introduction: The aim of our study was to assess the role of ECG-gated coronary CT angiography (CCTA) in the diagnosis, imaging follow-up, and treatment guidance in post-procedural/surgical interventions in the heart and thoracic aorta (PTCA, TAVI, PMK/ICD placement, CABGs). Materials and Methods: We retrospectively evaluated 294 ECG-gated CCTA studies performed in our center from January 2020 to January 2023. CCTA studies were acquired to detect/exclude possible complications related to the endovascular or surgical procedure. Results: There were 27 cases (9.2%) of post-procedural complications. Patients enrolled in the study were 18 males and 9 females (male/female ratio: 2), with age ranging from 47 to 86 years (mean age, 68.3 years). Among percutaneous coronary intervention (PCI) complications, coronary intimal dissection with ascending aorta involvement was found to be the most frequent complication after PTCA (22.2%). Vascular wall pseudoaneurysm formation (11.1%) and coronary stent misalignment or displacement (14.8%) were complications less frequently encountered after PTCA. Right atrial or ventricular perforation with associated hemopericardium were the most common complications (18.5%) after pacemaker implantation. Complications encountered after aortic valve interventions were loosening and dislocation of the prosthesis associated with aortic root pseudoaneurysm (7.4%), para-valvular leak (11.1%), and hemopericardium (7.4%). In one patient who underwent transcatheter repair of patent foramen ovale (3.7%), CTTA detected the dislocation of the Amplatzer septal occluder. Conclusions: ECG-gated CCTA is a fundamental diagnostic tool for the detection of post-procedural endovascular/surgical complications to enable optimal patient management. Radiologists must be familiar with the use of cardiac synchronization in the course of CT and must be aware of all possible complications that can occur in the context of acute settings or routine follow-up studies.
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Fathurohim, Zainal, Novi Kurnianingsih, Djanggan Sargowo, and Heny Martini. "Aortic Intramural Hematoma Mimicking Acute Coronary Syndrome." Heart Science Journal 4, no. 2 (2023): 23–25. http://dx.doi.org/10.21776/ub.hsj.2023.004.02.5.
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Type A Aortic intramural haematoma (IMH), a variant form of classic aortic dissection, has been accepted as an increasingly recognised and potentially fatal entity of acute aortic syndrome.It is a very dangerous, fatal, and emergency condition. It is very important to recognize the symptoms of acute aortic syndrome related to appropriate management Case Illustration A 52 year old man patient suffered from chest pain with moderate intensity while he was working at home. It was sharp , tear-like sensation, in the middle of the chest radiated to the back, accompanied with cold sweating, and did not relieve by rest. Because of this condition he brought to hospital. From examination at Emergency room, he had cardiomegaly, aortic dilatation. From the Electrocardiography an st elevation at V1-V2 and T inverted V4-V6 precordial lead,I aVL extremities lead and slightly elevated cardiac enzymes with risk factors for active smoking and uncontrolled hypertension. Initially he was suspected of having acute coronary syndrome with differential diagnose acute aortic syndrome. To exclude the diagnose he had underwent cardiac catheterization, the cardiologist in charge suspicious this patient with aortic dissection because of trapping contrast durante procedure and coronary minor disease. For a better diagnosis, transtransthoracic echocardiography and Aortic Computed Tomography angiography was performed on the patient which confirmed the evidence of dissection. After being diagnosed, we treat the patient as an acute aortic syndrome and we stabilize the patient's condition. The patient was planned for cardiac surgery Discussion Acute aortic syndrome, which includes Acute Aortic Dissection, Intramural Hematoma and penetrating aortic ulcer, is difficult to diagnosed. Aortic intramural hematoma, which is one of the acute aortic syndromes, is characterized by the presence of a hematoma in the medial layer of the aortic wall without the appearance of an intimal tear. The incidence of intramural hematoma differs slightly from that of aortic dissection syndrome. Patients with intramural hematomas often occur in older patients, more often with aortic aneurysms The patient receive treatment aggressively to control blood pressure by administering a non-dihydropyridine calcium channel blocker intravenously and then beta blocker, angiotensin II receptor blockers, was also needed. Acute aortic syndrome, where an intramural aortic hematoma can present with varying symptoms of varying severity, which can lead to misdiagnosis and delay in cases of life-threatening disease. In the case of our patient, who had strong cardiac risk factors, His initial presentation described an acute myocardial infarction; the diagnosis was made after CT scan was performed and the patient remained stable Conclussion Complaints of chest pain due to symptoms of acute aortic syndrome are very important to be recognized immediately because they need proper management. Complaints in this syndrome have similarities with complaints in acute coronary syndrome, pulmonary embolism and others. Patients with aortic intramural hematoma are at high risk for developing periaortic hematoma and hemorrhagic pericardial effusion. In patients with an intramural aortic hematoma, Stanford A, the most appropriate management is surgical technique. Initial management of blood pressure control, heart rate and anti-pain can be given. In this case, the choice of a combination of surgery with endovascular may be a logical choice of therapy
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Mertineit, Nando, Amgad El Mekabaty, Gholam Reza Afarideh, et al. "Splenic Artery Aneurysm Occlusion by Overlapping Gore® Viabahn® Endoprosthesis Devices." Swiss Journal of Radiology and Nuclear Medicine 10, no. 1 (2024): 1–18. http://dx.doi.org/10.59667/sjoranm.v10i1.12.
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The first lienal artery aneurysm was discovered and described for the first time in 1770 by the Frenchman Beaussier during an autopsy. It was first visualised using X-rays in 1920 by the physicians Akbulut and Otan. The first surgical treatment of a splenic artery aneurysm was performed by sur-geons MacLeod and Maurice in 1940. The first minimally invasive endovascular therapies using coils, stents or a combination of the two devices for minimally invasive treatment of aneurysms of the lienal artery were reported in 1990, 1994 and 1995 (1,2,3). 63-year-old patient with a known aneurysmal arteriopathy of the thoracic aorta in the sense of an aortic dissection in coexistence with a 2.2 cm splenic artery aneurysm discovered by chance in the vascular surgery department of the Bürgerspital Solothurn. The interdisciplinary consensus primarily favoured vascular surgery or minimally invasive transcatheter treatment to eliminate the splenic artery aneurysm. The dissected thoracic aortic aneurysm detected in the pre-interventional CT of the thorax and abdomen, extending into the abdominal aorta, (Fig. 1) should only be treated with minimally invasive endovascular treatment using EVAR after stenting of the lienal artery aneurysm detected by CT (Fig. 9, 10, 11). A reverse therapeutic sequence would have allowed access to the lienal artery aneurysm only by fenestration of the EVAR. For the treatment of our patient's wide-neck aneurysm, the use of a Viabahn was chosen from the many known and proven occlusion materials as a significantly less invasive alternative to surgical treatment of the aneurysm by interdisciplinary consensus. Due to a technical complication during the deployment of the first vial, a two-stage angiographic therapeutic intervention was necessary.
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Valente, Tullio, Giacomo Sica, Federica Romano, et al. "Non-A Non-B Acute Aortic Dissection: Is There Some Confusion in the Radiologist’s Mind?" Tomography 9, no. 6 (2023): 2247–60. http://dx.doi.org/10.3390/tomography9060174.
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Background: The aim of this study is to define and determine the rate of acute non-A–non-B aortic dissections, and to evaluate CT angiography findings and possible complications, as well as to discuss management strategies and currently available therapy. Non-A non-B type of aortic dissection is still a grey area in the radiologist’s mind, such that it is not entirely clear what should be reported and completed in terms of this disease. Methods: A retrospective single-center study including 36 pre-treatment CT angiograms of consecutive patients (mean age: 61 years) between January 2012 and December 2022 with aortic dissection involving the aortic arch with/without the thoracic descending/abdominal aorta (type non-A non-B). Results: According to the dissection anatomy, we identified three modalities of spontaneous acute non-A–non-B anatomical configurations. Configuration 1 (n = 25) with descending-entry tear and retrograde arch extension (DTA entry). Configuration 2 (n = 4) with Arch entry tear and isolated arch involvement (Arch alone). Configuration 3 (n = 7) with Arch entry and anterograde descending (±abdominal) aorta involvement (Arch entry). CT angiogram findings, management, and treatment options are described. Conclusions: Acute non-A non-B dissection represents an infrequent occurrence of aortic arch dissection (with or without involvement of the descending aorta) that does not extend to the ascending aorta. The complete understanding of its natural progression, distinct CT angiography subtypes, optimal management, and treatment strategies remains incomplete. Within our series, patients frequently exhibit a complex clinical course, often necessitating a more assertive approach to treatment compared to type B dissections.
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Tang, Huili. "Clinical Identification and Treatment of Aortic Dissection with Pericardial Effusion Before Intravenous Thrombolysis." Academic Journal of Science and Technology 2, no. 3 (2022): 81–83. http://dx.doi.org/10.54097/ajst.v2i3.1501.
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To detect aortic dissection complicated with pericardial effusion in time before intravenous thrombolysis, to avoid iatrogenic damage and get the rescue time. Methods: The data of 2 patients with aortic dissection complicated by pericardial effusion who entered the stroke greenway in our hospital in 2022 were collected. The literature on the diagnosis and treatment of aortic dissection and cardiac tamponade were reviewed. Results: The clinical features of aortic dissection complicated with pericardial effusion were sudden onset, rapid progression, and high risk of death. The chest CT scan showed linear high-density shadows in the aorta, enlarged cardiac shadows, and pericardial effusion. Echocardiography supported the diagnosis. Conclusion: Neurological deficit is a common complication of aortic dissection, including disturbance of consciousness, and intravenous thrombolysis is not suitable. Chest CT scan and bedside color Doppler ultrasound are important methods to quickly identify aortic dissection and pericardial effusion. Reasonable emergency pericardiocentesis can obtain valuable time for surgical treatment.
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Kurnia, Atthoriq Hayat, and Verry Gunawan Sohan. "An unusual phenomenon of recurrent aortic dissection with hypertension: a rare case report." Journal of Indonesia Vascular Access 3, no. 2 (2023): 29–32. http://dx.doi.org/10.51559/jinava.v3i2.42.
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Introduction: Recurrent aortic dissection is a rare and challenging phenomenon for cardiovascular cases in the world. In the last two decades among patients with initial aortic dissection, only 5% have become recurrent aortic dissection, typically seen in patients with connective tissue disorders. We report an unusual case of recurrent aortic dissection with hypertension. Case Presentation: A 55-year-old female came with complaints of chest pain from the mid and left chest to the back. The symptoms had occurred for almost three years after treatment and post-surgery of her prior aortic aneurysm dissection. But she still had the same signs and symptoms as before. We requested thoracoabdominal CT angiography to confirm the diagnosis. A thoracoabdominal CTA shows recurrent aortic dissection, because of its difficulty and rarity we need proper consideration. For now, we prefer conservative medical treatment with management of blood pressure and pain control, also treatment for other diseases. Conclusion: Recurrent aortic dissection is still a special challenge for physicians and a rare extreme phenomenon that may need a special approach and more complex treatment strategies.
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Shamizadeh, Soraya, and Golamreza Faridaalaee. "Atypical Presentation of Aortic Dissection: A Case Report." Disease and Diagnosis 10, no. 3 (2021): 129–31. http://dx.doi.org/10.34172/ddj.2021.24.
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Background: Aortic dissection (AD) is considered to be one of the life-threatening diseases. Quick diagnosis has great significance so that a one-hour delay in treatment leads to a 1-2% increase in mortality. Case Report: The 55-year old obese woman with epigastric pain and right upper quadrant pain referred to the emergency department of our hospital. The acute coronary syndrome was our initial diagnosis but an image similar to a Perl in one cut and a crescent in another cut of computed tomography (CT) drew our attention in the mediastinal view of CT without intravenous contrast that was performed to rule out coronavirus disease-19 (COVID-19). Finally, CT-angiography was requested and AD diagnosis was approved accordingly. Conclusion: The presence of calcification on a non-contrast chest CT in the middle of the aorta or away from the artery wall can be a sign of AD. Thus, special attention should be paid to the atypical symptoms of AD.
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Kalmar, Peter I., Peter Oberwalder, Peter Schedlbauer, Jürgen Steiner, and Rupert H. Portugaller. "Secondary Aortic Dissection after Endoluminal Treatment of an Intramural Hematoma of the Thoracoabdominal Aorta: Endovascular Extension with Two Stent Grafts and Scarce Distal Landing." Case Reports in Medicine 2013 (2013): 1–4. http://dx.doi.org/10.1155/2013/714914.
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Secondary dissection in the descending aorta after endovascular therapy may demand subsequent interventional procedures. This can set a particularly significant challenge for the endovascular specialist. When implanting an aortic prosthesis, a sufficient contact between the covered segment and the healthy vessel wall is advisable. However, our case shows that, in individual cases, it is indeed efficient to place an aortic stent graft on top of the distal end of the dissection. This is proven by a three-year follow-up CT-angiography.
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Sakalauskas, Juozas, Šarūnas Kinduris, Rimas Benetis, et al. "Surgical treatment of acute type A aortic dissection." Medicina 45, no. 3 (2009): 192. http://dx.doi.org/10.3390/medicina45030025.
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The objective of this study was to evaluate the short-term results of surgical treatment in patients with acute aortic dissection. Patients and methods. A retrospective analysis of 38 patients with acute type A aortic dissection who were surgically treated at the Clinic of Cardiac, Thoracic, and Vascular Surgery, Hospital of Kaunas University of Medicine, from January 2004 to December 2007 was conducted. The diagnosis of aortic dissection was confirmed by employing special techniques. Two-dimensional transthoracic echocardiography was performed in 34 (89.5%) patients; transesophageal echocardiography, in 24 (63.1%); computed tomography, in 29 (76.3%); coronagraphy and angiography, in 20 (52.6%). Preoperative shock was reported in 3 (7.9%) and cardiac tamponade in 18 (47.4%) cases. More than half (57.9%) of patients were operated on within the first 24 hours after admission. In the majority of cases (73.7%), the diameter of the aorta exceeded 4 cm. In the presence of type A aortic dissection, all patients underwent surgery on cardiopulmonary bypass; its duration varied from 20 to 485 min, with a mean of 214.6±102.9 min. The mean aortic cross-clamp time was 114.5±62.7 min. Complete circulatory arrest was needed in the majority of cases (86.8%), and it lasted 2 to 97 min (mean, 27.4±18.6 min). During cardiopulmonary bypass, body temperature was decreased to 17–28°C (mean, 18.9±1.95°C). The duration of surgery ranged from 1 to 14 hours, with a mean of 6.1±2.49 hours. During the early postoperative period, 12 (31.6%) patients died. Postoperative bleeding was seen in 16 (42.1%) patients, and 6 of them died later. Due to prolonged bleeding, 4 (10.5%) patients were left with an open sternum after surgery. Resternotomy was performed in 9 patients; 3 of them died due to multiorgan injury. During postoperative period, cardiogenic shock of various degrees was seen in 7 (18.4%) patients. Central nervous system injury occurred in 9 (23.7%) patients. Conclusion. The main risk factor for acute aortic dissection is the diameter of the aorta exceeding 4 cm (diagnosed in 73.7% of cases). The main postoperative complications are bleeding (42.1%), injuries of central nervous system (23.7%), and cardiogenic shock (18.4%).
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Jha, Vivek, Sanjay Bhadada, Liza Das, and Santosh Kumar. "Acute aortic dissection related to bilateral pelvic paragangliomas." BMJ Case Reports 17, no. 11 (2024): e261425. http://dx.doi.org/10.1136/bcr-2024-261425.
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A female in late adolescence with severe chest pain, dyspnoea, diaphoresis and dizziness presented to the emergency department where she was found to have exceptionally high blood pressure (250/150 mm Hg) and a diastolic murmur. Initial examinations showed left ventricular hypertrophy, and urgent CT angiography confirmed a Stanford type A aortic dissection. Following successful surgical repair, further evaluations were prompted by her persistent, drug-resistant hypertension, revealing elevated normetanephrine and 3-methoxytyramine. Subsequent imaging identified bilateral pelvic paragangliomas, which were surgically removed, significantly reducing her hypertension. Her postoperative period showed biochemical remission, and genetic testing was positive for germline SDHB mutation. Monitoring and follow-up imaging are ongoing. This case highlights the rare association of pelvic paragangliomas with acute aortic dissection in young adults, emphasising the importance of possible endocrine hypertension in young people with hypertensive emergencies.
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Faruk Doğan, Ömer, Muhittin Zafer Samsa, Mete Kubilay Kasap, and Özgür Çoban. "[MEP-26] Safety and Efficacy of Endovascular Repair Using Multilayer Flow Modulators for Thoracic Aortic Aneurysms After Type 1 Aortic Dissection." Cardiovascular Surgery and Interventions 11, no. 100 (2024): 87. https://doi.org/10.5606/e-cvsi.2024.mep-26.
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Objective: This study aimed to explore the outcomes of thoracic endovascular aortic aneurysm repair (TEVAR) for thoracic aortic aneurysms (TAAs) with or without concurrent endovascular abdominal aneurysm repair (EVAR) using multilayer flow modulator stents. Methods: This study included 23 patients (16 males, 7 females; mean age: 64 years) who underwent acute type 1 ascending aortic dissection repair. Symptoms varied from chest and abdominal pain, dyspnea, and fatigue to asymptomatic cases. Multislice computed tomography (CT) angiography assessed all segments of the aorta. We identified TAAs in all patients, with four also having abdominal aneurysms. All patients underwent TEVAR, and EVAR was added when necessary, using a multilayer flow modulator. Control CT angiography was conducted one month after discharge. Results: There were no deaths or major complications. The median interval between primary surgery and CT angiography was 19 months (range, 6 to 60 months). The median hospital stay was 4.2 days. Control angiograms demonstrated 100% technical success with patent aortic lumens and branches. The only complication was a superficial infection in the femoral region. No cases of aortic rupture, stent migration, thrombosis, or stent fracture were observed. One patient had an endoleak at proximal and distal aortic ends, which was addressed with an additional multilayer flow modulator. Conclusion: Thoracic aortic aneurysms with or without abdominal aneurysms should be considered after type I aortic dissection surgery. We recommend it as an effective treatment method because it does not obstruct blood flow in the visceral arteries in patients with complex aortic aneurysms. Further randomized clinical trials are necessary to validate the effectivity of multilayer flow modulator stent.
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Faruk Doğan, Ömer, Muhittin Zafer Samsa, Mete Kubilay Kasap, and Özgür Çoban. "[MEP-26] Safety and Efficacy of Endovascular Repair Using Multilayer Flow Modulators for Thoracic Aortic Aneurysms After Type 1 Aortic Dissection." Turkish Journal of Thoracic and Cardiovascular Surgery 32, no. 4 (2024): 124. https://doi.org/10.5606/tgkdc.dergisi.2024.mep-26.
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Objective: This study aimed to explore the outcomes of thoracic endovascular aortic aneurysm repair (TEVAR) for thoracic aortic aneurysms (TAAs) with or without concurrent endovascular abdominal aneurysm repair (EVAR) using multilayer flow modulator stents. Methods: This study included 23 patients (16 males, 7 females; mean age: 64 years) who underwent acute type 1 ascending aortic dissection repair. Symptoms varied from chest and abdominal pain, dyspnea, and fatigue to asymptomatic cases. Multislice computed tomography (CT) angiography assessed all segments of the aorta. We identified TAAs in all patients, with four also having abdominal aneurysms. All patients underwent TEVAR, and EVAR was added when necessary, using a multilayer flow modulator. Control CT angiography was conducted one month after discharge. Results: There were no deaths or major complications. The median interval between primary surgery and CT angiography was 19 months (range, 6 to 60 months). The median hospital stay was 4.2 days. Control angiograms demonstrated 100% technical success with patent aortic lumens and branches. The only complication was a superficial infection in the femoral region. No cases of aortic rupture, stent migration, thrombosis, or stent fracture were observed. One patient had an endoleak at proximal and distal aortic ends, which was addressed with an additional multilayer flow modulator. Conclusion: Thoracic aortic aneurysms with or without abdominal aneurysms should be considered after type I aortic dissection surgery. We recommend it as an effective treatment method because it does not obstruct blood flow in the visceral arteries in patients with complex aortic aneurysms. Further randomized clinical trials are necessary to validate the effectivity of multilayer flow modulator stent.
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Giudice, Rocco, Antonio Frezzotti, and Marco Scoccianti. "Intravascular Ultrasound—Guided Stenting for Chronic Abdominal Aortic Dissection." Journal of Endovascular Therapy 9, no. 6 (2002): 926–31. http://dx.doi.org/10.1177/152660280200900631.
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Purpose: To describe how the combined use of duplex and intravascular ultrasound (IVUS) can assist in the evaluation and treatment of isolated abdominal aortic dissection without need for contrast angiography. Case Report: A 78-year-old man presented with intermittent bilateral buttock and thigh claudication. Duplex ultrasound and contrast-enhanced computed tomography (CT) confirmed a chronic dissection along 3 to 4 cm of the infrarenal abdominal aorta. During Extra Large Palmaz stent implantation, the procedure was based on IVUS images and fluoroscopy without angiography. Both duplex and IVUS images were critical in assessing the type and extent of the lesion to be treated, in guiding the procedure, and in assessing its satisfactory outcome. Conclusions: In selected cases, ultrasound-based imaging modalities can provide most of the information required to accomplish complex aortic procedures.
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Akhmedov, Z. R., S. S. Niyazov, V. S. Selyaev, et al. "he Successful Replacement of Aortic Valve and Ascending Aorta in Patients with Type A Aortic Dissection in the Postpartum Period. The Analysis of Literature and Demonstration of Own Observations." Russian Sklifosovsky Journal "Emergency Medical Care" 12, no. 3 (2023): 497–504. http://dx.doi.org/10.23934/2223-9022-2023-12-3-497-504.
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Abstract. Aortic dissection is a rupture of the inner layer of the aorta with subsequent penetration of blood into the degeneratively altered middle layer with the formation of false lumen and true lumen. Pregnancy is one of the risk factors for the development of aortic dissection. The incidence of aortic dissection during pregnancy is only 0.0004% of cases.Aim of the study. To analyze national and foreign literature, as well as share own clinical observations in the diagnosis and treatment of patients with aortic dissection in the postpartum period.Material and methods. Two patients after successful childbirth, in the late postpartum period, were admitted with a diagnosis of aortic dissection type A according to Stanford.CT angiography confirmed the presence of Stanford type A aortic dissection. After additional examination, surgical treatment was performed to replace the aortic valve and ascending aorta under artificial circulation, with a satisfactory clinical result.Conclusion. The diagnosis of aortic dissection should be considered in all pregnant women with chest pain, as this condition often goes undiagnosed.The pregnancy period is one of the risk factors for the development of aortic dissection with a high mortality rate. The likelihood of developing aortic dissection in women at risk peaks in the third trimester and the first 12 weeks after delivery.The risk group should include women with confirmed syndromic and non-syndromic genetic diseases, bicuspid aortic valve, coarctation of the aorta, or at least one major criterion indicating the presence of aortopathy (ectopia lentis, aortic aneurysm, habitus, genetic testing).If Marfan syndrome is present, surgical intervention should be considered if the maximum aortic diameter is more than 4.5 cm before pregnancy. In women with Marfan syndrome and aortic dissection in the family history, as well as in the presence of more aggressive genetic diseases (Loeys-Dietz syndrome, Ehlers-Danlos syndrome), it is possible to consider preventive surgical treatment for an aortic diameter of 4.0 cm or more.The delivery in high-risk patients is recommended to be performed in a hospital that has a cardiac surgery service and an “aortic” team.
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Sakamoto, Ichiro, Naohiro Matsuyama, Aya Fukushima, et al. "Chronic Aortic Dissection Complicated by Disseminated Intravascular Coagulation: Successful Treatment with Endovascular Stent-Grafting." Journal of Endovascular Therapy 10, no. 5 (2003): 953–57. http://dx.doi.org/10.1177/152660280301000519.
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Purpose: To report endovascular repair of a chronic aortic dissection complicated by disseminated intravascular coagulation (DIC). Case Report: A 61-year-old man developed DIC associated with a chronic Stanford type B aortic dissection that occurred during cardiac catheterization 12 years earlier. At the current admission, computed tomography showed a partially thrombosed false lumen extending from the aortic arch to the left common iliac artery. On angiography, entry and re-entry tears were identified at the right subclavian and left common iliac arteries, respectively. After stent-graft implantation at the entry and re-entry sites, not only was the false lumen completely thrombosed but the DIC also resolved. The patient is doing well with no complication at 16 months after treatment. Conclusions: Endovascular stent-grafting is an acceptable alternative to surgical repair for aortic dissection accompanied by DIC.
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A, Aishwarya, and Nilu Sunil. "What May Stand Behind Chest Pain: A Case Report on Aortic Dissection." Journal of the Association of Physicians of India 1, no. 1 (2023): 31–35. http://dx.doi.org/10.5005/njem-11015-0004.
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Aortic dissection (AD) is a relatively uncommon, rare disorder and potentially misdiagnosed disease. Early diagnosis and treatment is required for the patient's survival. Aortic dissection can be fatal if misdiagnosed. A 50-year-old adult male presented to emergency with acute chest pain and having a medical history of aortic stenosis post-aortic valve replacement 9 months back and a family history of ischaemic heart disease. Pain was relieved by analgesics. After further investigations by echocardiography and CT Angiography, it was diagnosed as AD Standford type A and DeBakey type 1, in view of the critical nature of illness, patient attenders wanted only medical management. The patient was declared dead after 2 days of diagnosis.
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Omar, Sabry, Tyler Moore, Drew Payne, et al. "Familial Thoracic Aortic Aneurysm with Dissection Presenting as Flash Pulmonary Edema in a 26-Year-Old Man." Case Reports in Medicine 2014 (2014): 1–4. http://dx.doi.org/10.1155/2014/842872.
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We are reporting a case of familial thoracic aortic aneurysm and dissection in a 26-year-old man with no significant past medical history and a family history of dissecting aortic aneurysm in his mother at the age of 40. The patient presented with cough, shortness of breath, and chest pain. Chest X-ray showed bilateral pulmonary infiltrates. CT scan of the chest showed a dissection of the ascending aorta. The patient underwent aortic dissection repair and three months later he returned to our hospital with new complaints of back pain. CT angiography showed a new aortic dissection extending from the left carotid artery through the bifurcation and into the iliac arteries. The patient underwent replacement of the aortic root, ascending aorta, total aortic arch, and aortic valve. The patient recovered well postoperatively. Genetic studies of the patient and his children revealed no mutations in ACTA2, TGFBR1, TGFBR2, TGFB2, MYH11, MYLK, SMAD3, or FBN1. This case report focuses on a patient with familial TAAD and discusses the associated genetic loci and available screening methods. It is important to recognize potential cases of familial TAAD and understand the available screening methods since early diagnosis allows appropriate management of risk factors and treatment when necessary.
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Hda, MA, Y. Bougrini, R. Belghol, and A. Ouarsani. "LEFT HEMOTHORAX: UNUSUAL MANIFESTATION OF AORTIC DISSECTION." International Journal of Advanced Research 12, no. 01 (2024): 917–21. http://dx.doi.org/10.21474/ijar01/18203.
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Aortic dissection is a medical and surgical emergency often revealed by acute chest pain. Its discovery in the context of hemorrhagic pleurisy is rare, and it often poses a diagnostic challenge.We report the case of a 52-year-old patient with a history of chronic smoking, without known arterial hypertension, admitted forexploring a moderately abundant left pleural effusion. Pleural puncture yielded non-coagulable hemorrhagic fluid. Thoracic angio-CT scan revealed a type B aortic dissection (Stanford classification). In the absence of surgical indication, antihypertensive treatment was initiated in this patient, combined with close medical monitoring. The course was marked by the death of the patient after refractory hemorrhagic shock.Aortic dissection should be systematically considered in the presence of any spontaneous hemothorax, even in the absence of suggestive clinical signs.
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Abdulhameed, Koyan. "POST-COARCTATION INTERVENTION: CT-ANGIOGRAPHY ARCH MORPHOLOGY FINDING VERSUS ECHO FINDING." Journal of Sulaimani Medical College 14, no. 3 (2024): 303–14. https://doi.org/10.17656/jsmc.10478.
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Aortic Arch Morphological Assessment with Echocardiography and Computerized Tomography-Angiography The study is based on the case of coarctated aorta whose it is one of the most occurrence diseases among congenital cardiovascular malformations in newborns. The study would evaluate the suitability and efficiency between the two before and after treatment. The findings of this study may be applied to later make clinical decisions as well as develop patient’s treatment policy. Objectives Compare Echocardiography findings with Computerized Tomography-Angiography outcomes for evaluation of post-coarctation aortic arch morphology. Patients and Methods People in the study had undergone coarctation repair either surgical or interventional techniques; they were subjected to echocardiography and Computerized Tomography-Angiography follow up post intervention. Results The study says that comparing Computerized Tomography-Angiography and echocardiography to look at the shape of the aortic arch after coarctation intervention showed big differences. The mean aortic diameter measurements were different between the two imaging methods (for each patient four readings were taken for each modality). The third reading with echocardiography showed a larger mean diameter, which was statistically significant (p 0.001). According to the findings of the Spearman test, there was no appreciable positive correlation between the readings from the two modalities. The study emphasizes the significance of cautious modality selection depending on the clinical circumstances for accurate assessment and the best possible patient treatment. Conclusion The study thoroughly compares the evaluation of post-interventional coarctation of the Aorta patients using the Computerized Tomography-Angiography and echocardiography methodologies. The two imaging procedures were very close except for minute differences that proved useful. nonetheless, every patient must be carefully evaluated independently. This study emphasized choosing imaging modality with a true picture of the patient’s condition so that it would be appropriate for them to use Computerized Tomography-Angiography and echocardiography. The procedure for enlarging the coarctation and assisting in post-surgical recovery of patients. As such, further investigations may be conducted to establish if the images will predict future clinical outcomes.
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Hafeez, Adam, Dillon Karmo, Adrian Mercado-Alamo, and Alexandra Halalau. "Aortic Dissection Presenting as Acute Pancreatitis: Suspecting the Unexpected." Case Reports in Cardiology 2018 (2018): 1–4. http://dx.doi.org/10.1155/2018/4791610.
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Aortic dissection is a life-threatening condition in which the inner layer of the aorta tears. Blood surges through the tear, causing the inner and middle layers of the aorta to separate (dissect). It is considered a medical emergency. We report a case of a healthy 56-year-old male who presented to the emergency room with sudden onset of epigastric pain radiating to his back. His blood pressure was 167/91 mmHg, equal in both arms. His lipase was elevated at 1258 U/L, and he was clinically diagnosed with acute pancreatitis (AP). He denied any alcohol consumption, had no evidence for gallstones, and had normal triglyceride level. Two days later, he endorsed new suprapubic tenderness radiating to his scrotum, along with worsening epigastric pain. A MRCP demonstrated evidence of an aortic dissection (AD). CT angiography demonstrated a Stanford type B AD extending into the proximal common iliac arteries. His aortic dissection was managed medically with rapid blood pressure control. The patient had excellent recovery and was discharged home without any surgical intervention.
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Gordeev, M. L., V. E. Uspenskiy, A. Y. Bakanov, et al. "Aortic arch reconstruction in surgical treatment of ascending aortic aneurysms and dissections." Patologiya krovoobrashcheniya i kardiokhirurgiya 20, no. 4 (2016): 45. http://dx.doi.org/10.21688/1681-3472-2016-4-45-57.
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<p><strong>Aim.</strong> The study focused on the analysis of short-term results of aortic arch reconstruction in patients undergoing open heart surgery for ascending aortic aneurysms and dissections, comparison of intra-operative brain protection methods and verification of predictors of complications.<br /><strong>Methods.</strong> 84 patients (mean age 55.5 ± 11.5 years, 72.6 % (61) males) with ascending aortic aneurysms and Stanford type A ascending aortic and arch dissections underwent surgery over a period from January, 2013, to March, 2015. Patients were divided into 3 groups. The 1st group included patients with ascending aortic aneurysm combined with aortic dilatation at the level of innominate artery &gt;4.0 cm (n = 41). The 2nd group consisted of patients with Stanford type A acute ascending aortic and arch dissection (n = 25). In the 3rd group there were patients with type A chronic ascending aortic and arch dissection (n = 18). No significant differences between the groups were observed. Mean values of the maximum ascending aortic diameter did not differ significantly and were 59.6, 58.4 and 62.4 mm in the 1st, 2nd and 3rd groups, respectively. 3 patients from the 2nd group presented with acute heart failure, 6 – acute myocardial infarction, and 3 – stroke. Higher values of pressure gradient on the aortic valve were registered in the 1st group, as compared to those in the 2nd and 3rd groups (mean value of the peak gradient was 4.5, 8.1 and 12.4 mm Hg, respectively). EuroSCORE II value in the 1st , 2nd and 3rd groups was 9.4 %, 17.7 % and 5.8 %, respectively. <br /><strong>Results.</strong> Overall hospital mortality was 1.2 %: 1 patient with acute type A aortic dissection and later dissection of innominate artery developed stroke and died due to multiple organ failure. More prolonged cardiopulmonary bypass time and aortic cross-clamp time were required for patients with acute ascending aortic dissections, but the total surgery time and circulatory arrest time differed significantly only in the 2nd and 3rd groups. Lengthy inotropic support, ventilation time and total ICU stay, as well as a higher rate of neurologic disorders in patients with aortic dissections in comparison with patients with aneurysms were observed. We verified correlation of the urgent type of surgery, acute type A aortic dissection, including arch and descending thoracic aortic dissection, also with dissection of cervicocerebral arteries, with a more complicated hospital period, increased inotropic support and prolonged duration of stay in the intensive care unit.<br /><strong>Conclusion</strong>. Hemiarch repair of aortic arch dilatation in case of ascending aortic replacement is an effective and safe method of treatment of extended ascending aortic aneurysms and dissections. Unilateral anterograde cerebral perfusion with simultaneous crossclamping of contralateral common carotid artery allows to maintain effective cerebral protection in conditions of moderate hypothermia and duration of circulatory arrest for at least 30-40 minutes. Adverse prognostic factors are urgent surgery, ascending aortic, arch and descending thoracic aortic dissection, prolonged extracorporeal circulation and myocardial ischemia, and disuse of the axillary artery for cannulation.</p><p>Received 6 October 2016. Accepted 24 November 2016.</p><p><strong>Funding:</strong> The study was carried out within the government’s task for 2015-2017, “Cardiovascular pathologies”, theme No. 4 “Research on genome and cellular mechanisms of formation of aorta and aortic valve pathology and development of new methods for its treatment including hybrid technologies”.<br /><strong>Conflict of interest:</strong> The authors declare no conflict of interest.<br /><strong>Author contributions</strong><br />Material acquisition and analysis: Gordeev M.L., Uspenskiy V.E., Bakanov A.Y., Volkov V.V., Ibragimov A.N., Scherbinin T.S., Irtyuga O.B., Naimushin A.V. <br />Article writing: Gordeev M.L., Uspenskiy V.E., Bakanov A.Y. <br />Review &amp; editing: Gordeev M.L., Naimushin A.V.<br /><strong>Acknowledgment</strong><br />The authors express their gratitude for support in diagnostics and management of patients with aortic abnormalities to I. V. Basek, PhD, Head of X-Ray CT Department, and to the employees of X-ray CT Department; to D.A. Zverev, PhD, Head of X-ray Endovascular Surgery Research Lab and the employees of X-ray Endovascular Surgery Departments; O.M. Moiseyeva, Doc. Sci. (Medicine), Head of Noncoronarogenic Heart Diseases Department and her employees, as well as to the employees of Anesthesiology &amp; Resuscitation and Cardiovascular Surgery Departments.</p>
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Segreto, A., C. Pisano, S. Torre, et al. "EXTENSIVE VERSUS CONVENTIONAL TREATMENT FOR TYPE A AORTIC DISSECTION: PRELIMINARY RESULTS OF ASCYRUS MEDICAL DISSECTION STENT." Journal of Cardiovascular Medicine 25, Supplement 1 (2024): e8. https://doi.org/10.2459/01.jcm.0001096208.36126.11.
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Background and Aim: Acute type A aortic dissection (ATAAD) is a critical condition typically managed with high risks extensive surgical interventions, such as open aortic repair, especially for patients with complex anatomies or comorbidities. AMDS offers a less invasive, hybrid approach that stabilizes the true lumen and promotes aortic remodeling, potentially reducing the need for more complex surgery and rate of reintervention. This study compares preliminary outcomes between patients treated with AMDS in Zone 0 and those undergoing conventional surgical treatment such as Ascending aortic replacement ± hemiarch. Methods: Between August 2019 and August 2024 we treated 70 patients for ATAAD. Excluding 54 patients treated with arch replacement and reimplantation of epiaortic vessels, this retrospective analysis compares 8 patients treated with AMDS (AMDS group) and 8 patients treated with ascending aortic replacement ± hemiarch (control group). We collected data on demographics, clinical characteristics, procedural details, and postoperative outcomes. Results: The median age was 57 years for the AMDS group and 66.5 years for the control group. Although there was no significant difference in procedural times and in-hospital mortality between the groups we found a significant difference in aortic remodeling in the AMDS group on follow-up CT scans with complete or partial false lumen thrombosis. Conclusions: AMDS appears to be a promising alternative to conventional surgery for ATAAD, showing improved aortic remodeling despite similar in-hospital mortality rates. However, further studies with larger sample sizes and longer follow-up are needed to confirm the long-term safety and efficacy of AMDS in ATAAD management.
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Giribono, Anna Maria, Doriana Ferrara, Flavia Spalla, et al. "Endovascular treatment of spontaneous isolated abdominal aortic dissection." Acta Radiologica Open 5, no. 12 (2016): 205846011668104. http://dx.doi.org/10.1177/2058460116681042.
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Isolated abdominal aortic dissection is a rare clinical disease representing only 1.3% of all dissections. There are a few case series reported in the literature. The causes of this pathology can be spontaneous, iatrogenic, or traumatic. Most patients are asymptomatic and symptoms are usually abdominal or back pain, while claudication and lower limb ischemia are rare. Surgical and endovascular treatment are two valid options with acceptable results. We herein describe nine cases of symptomatic spontaneous isolated abdominal aortic dissection, out of which four successfully were treated with an endovascular approach between July 2003 and July 2013. All patients were men, smokers, symptomatic (either abdominal or back pain or lower limb ischemia), with a history of high blood pressure, with a medical history negative for concomitant aneurysmatic dilatation or previous endovascular intervention. Diagnosis of isolated abdominal aortic dissection were established by contrast-enhanced computed tomography angiography (CTA) of the thoracic and abdominal aorta. All nine patients initially underwent medical treatment. In four symptomatic cases, non-responsive to medical therapy, bare-metal stents or stent grafts were successfully positioned. All patients completed a CTA follow-up of at least 12 months, during which they remained symptom-free. Endovascular management of this condition is associated with a high rate of technical success and a low mortality; therefore, it can be considered the treatment of choice when it is feasible.
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Su, Mingming, Lili Zhao, Jing Zhou, Xuan Li, and Ning Ding. "Celiac trunk aortic dissection induced by bevacizumab therapy for rectal cancer: A case report." Medicine 103, no. 28 (2024): e38882. http://dx.doi.org/10.1097/md.0000000000038882.
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Rationale: Bevacizumab (Bev) is a humanized monoclonal antibody that targets vascular endothelial growth factor A and is primarily used for the treatment of various solid tumors. Aortic dissection (AD) is a severe vascular disease caused by the tearing of the intimal layer of the aorta or bleeding within the aortic wall, resulting in the separation of different layers of the aortic wall. However, the pathogenesis is not fully understood. Some studies have suggested that Bev treatment is associated with the occurrence of AD. Patient concerns: A 67-year-old Chinese male was diagnosed with rectal cancer accompanied by liver and lung metastasis. Three days after starting combined chemotherapy with Bev, the patient developed persistent abdominal pain. Abdominal CT scan revealed celiac trunk AD in the abdominal aorta. Diagnoses: The patient was diagnosed with rectal cancer accompanied by liver and lung metastases. Abdominal CT tomography revealed a celiac trunk AD. Interventions: Somatostatin combined with valsartan was used to control blood pressure. The patient was subsequently referred for vascular surgery and underwent an abdominal aortic angiography. Conservative treatment was continued. Outcomes: Three months after the initiation of treatment, follow-up abdominal CT scans showed stability in the condition of celiac trunk AD, with no abdominal pain or hypertension. There were no signs of worsening dissection, aneurysm formation, or inadequate perfusion of end organs. Lessons: There may be a connection between Bev and elevated blood pressure as well as celiac trunk AD.
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Foroni, M., M. Schiavo, V. Pagano, F. Bendandi, and F. Saia. "P343 WHAT IS HIDING BEHIND A ‘STEMI‘?" European Heart Journal Supplements 25, Supplement_D (2023): D178—D179. http://dx.doi.org/10.1093/eurheartjsupp/suad111.416.
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Abstract Introduction Stanford type A aortic dissection associated with ST–segment elevation myocardial infarction (STEMI) is a rare event with a high mortality rate. Emergency coronary angiography and antithrombotic therapy expose to a greater risk of complications and mortality. Case presentation: A 57–year–old heavy smoker gentleman with no previous medical history was admitted to the emergency department due to the sudden onset of severe oppressive chest pain. The ECG was suggestive of inferior STEMI and thus he was brought to the cath lab. During coronary angiography, there was spontaneous regression of the ST–segment alterations with persistence, however, of chest pain. The coronary angiography was unremarkable, but the cannulation of the right coronary artery was unexpectedly difficult. In light of the clinic and the suspicious fluoroscopic images (dilated aorta and severe valvular calcifications), an aortography was performed showing a type A aortic dissection. CT angiography confirmed the presence of dissection confined to the ascending aorta with origin of the right coronary artery from the false lumen. The supra–aortic trunks were not involved by the dissection. A bicuspid aortic valve and a bovine trunk were also found. The patient therefore underwent emergency cardiac surgery: a composite aortic valve conduit (Bentall procedure) was implanted and double aorto–coronary bypass surgery was performed, due to intraoperative evidence of complete detachment of the right coronary ostium and partial detachment of the left. The operation was successful and the following hospitalization was uneventful. Conclusions This case report exemplifies an important alternative diagnosis in patients referred for STEMI, particularly if with an inferior localization (the right coronary artery is the most frequently involved by the dissection). It is necessary to pay attention to the possible clues coming from the clinical findings and from the radioscopic and angiographic images obtained in the cath lab in order not to miss the diagnosis of a pathology on whose recognition and timely treatment the patient‘s life depends.
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Chapot, René, Armand Aymard, Jean-Pierre Saint-Maurice, Alain Bel, Jean-Jacques Merland, and Emmanuel Houdart. "Coil Embolization of an Aortic Arch False Aneurysm." Journal of Endovascular Therapy 9, no. 6 (2002): 922–25. http://dx.doi.org/10.1177/152660280200900630.
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Purpose: To report the endovascular occlusion of an anastomotic false aneurysm of the ascending aorta. Case Report: A 51-year-old patient developed an anastomotic false aneurysm at the level of the aortic arch after surgical replacement of the aortic root and arch for aortic dissection. The aneurysm expanded after 6 months and because of its saccular shape was treated by selective occlusion with detachable microcoils. Magnetic resonance angiography showed the stability of the occlusion after 2 years. Conclusions: Endovascular treatment with coils may be a good alternative to surgery for saccular anastomotic false aneurysms.
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Geibprasert, S., T. Krings, J. Apitzsch, M. H. T. Reinges, K. W. Nolte, and F. J. Hans. "Subarachnoid Hemorrhage following Posterior Spinal Artery Aneurysm." Interventional Neuroradiology 16, no. 2 (2010): 183–90. http://dx.doi.org/10.1177/159101991001600211.
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Isolated posterior spinal artery aneurysms are rare vascular lesions. We describe the case of a 43-year-old man presenting with spinal subarachnoid hemorrhage after a minor trauma who was found to have a dissecting aneurysm of a posterior spinal artery originating from the right T4 level. Endovascular treatment was not contemplated because of the small size of the feeding artery, whereas surgical resection was deemed more appropriate because of the posterolateral perimedullary location that was well appreciated on CT angiography. After surgical resection of the aneurysm the patient had a complete neurological recovery. In comparison to anterior spinal artery aneurysms whose pathogenesis is diverse, posterior spinal aneurysms are most often secondary to a dissection and represent false or spurious aneurysms. Although the definite diagnosis still requires spinal angiography, MRI and CT may better delineate the relationship of the aneurysm to the spinal cord in order to determine the best treatment method. Prompt treatment is recommended as they have high rebleeding and mortality rates.
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Faries, Peter L., Elvira Lang, Pranay Ramdev, Larry H. Hollier, Michael L. Marin, and Frank B. Pomposelli. "Endovascular Stent-Graft Treatment of a Ruptured Thoracic Aortic Ulcer." Journal of Endovascular Therapy 9, no. 2_suppl (2002): II—20—II—24. http://dx.doi.org/10.1177/15266028020090s204.
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Purpose: To describe a ruptured ulcer of the descending thoracic aorta treated with an endovascular stent-graft deployed under transesophageal echocardiographic (TEE) guidance. Case Report: An 82-year-old man with severe chronic obstructive pulmonary disease and congestive heart failure presented with sharp pain in the back radiating to the left flank. Computed tomography (CT) and angiography demonstrated a penetrating ulcer of the descending thoracic aorta associated with aortic dissection commencing 6 cm from the origin of the left subclavian artery with extravasation of contrast outside the aortic wall. The patient remained symptomatic with a decrease in hematocrit from 36% to 23%. Endovascular repair was performed using self-expanding nitinol stents sutured to a 35-mm × 12-cm Dacron conduit. The device was deployed with a 24-F delivery system under TEE guidance and fluoroscopy. Successful exclusion of the ruptured ulcer was demonstrated by TEE Doppler, arteriography, and CT. The patient remains asymptomatic 18 months after the procedure with no CT evidence of endoleak. Conclusions: Endovascular stent-graft repair under TEE guidance assists in the oftentimes difficult treatment of ruptured penetrating thoracic aortic ulcer.
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Jaafar, Rhissassi Hicham Wazaren Hanaa Bouhdadi, and Laaroussi Zakariya E.L. Arbaoui and Mohammed Cherti Mohamed. "AORTIC DISSECTION RETROSPECTIVE STUDY OF A SERIES OF 20 CASES." January 16, 2020. https://doi.org/10.5281/zenodo.3663635.
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Aortic dissection is a very serious condition that must be recognized early and whose treatment is a medical and surgical emergency. Management involves multidisciplinary expertise. In our retrospective study, we report 20 cases of aortic dissection surgically treated at Department of Cardiovascular Surgery at the University Hospital Avicenne of Rabat between 2004 and 2019, we analyze the epidemiological, clinical, paraclinical and surgical techniques performed in order to know the advantage very serious condition and hope for a better support. The average age in our study was 55 years with a male predominance, the main risk factor is hypertension, which was present in 14 of our patients. The master of the symptom is chest pain that is a constant sign in all patients and review key diagnostic confirmation is CTA in the absence of TOE emergency. All dissections were type A surgically treated.The surgery was based primarily on the Bentall technique consisting in the replacement of the ascending aorta dissected and aortic valve prosthesis in a synthetic in 13 of cases, while 7 cases underwent a replacement of aorta dissected by a prosthetic tube Dacron extra coronary position. The average duration of CPB and aortic clamping were 160 +/-20 min and 120 +/- 20min respectively with the implementation of a femoral cannulation sometimes associated with cannulationbicarotidienne The intra-hospital mortality rate was 35%, 5 patients died following bleeding one patient died from biventricular dysfunction and one patient died from renal failure others showed a favorable trend with simple post-operative within our service.
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Kulyk, L., D. Beshley, I. Protsyk, et al. "Classification of Dissecting Aortic Aneurysm as a Guide for Surgical Management." Ukrainian journal of cardiovascular surgery, April 16, 2020, 61–68. http://dx.doi.org/10.30702/ujcvs/20.3905/029061-068.
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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.
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Youssef Hassan, A., H. Kandil, H. Heshmat, M. Ali Salem, M. Meshaal, and A. Shehata. "P3379Diagnostic value of cardiac computed tomographic angiography in suspected prosthetic valve dysfunction." European Heart Journal 40, Supplement_1 (2019). http://dx.doi.org/10.1093/eurheartj/ehz745.0255.
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Abstract Background Echocardiographic assessment of prosthetic mechanical valves is limited by shadows, artefacts and the need for cumbersome Doppler calculations. CT scan has the potential to overcome some of the limitations of echocardiography in assessment of prosthetic valves. Objectives Determine the incremental diagnostic value of cardiac computed tomographic angiography (CTA) over transesophageal echocardiography (TEE) in patients with suspected prosthetic valve dysfunction (PVD) and its impact on treatment decisions. Methods 50 consecutive patients with suspected PVD underwent both 64-slice ECG-gated CT and TEE and the results were compared. Imaging was compared against surgical findings (Reference standard). Echocardiographic evaluation focused on the detection of signs of PVD: vegetations, new or increased paravalvular leakage (PVL), aortic root pseudoaneurysms or abscesses and occluder malfunction. The CT interpreter was blinded to the findings of TEE. Results ECG-gated CT showed findings that were not detected by TEE in fifteen patients (30%). Additional aortic root abscess in four patients (8%), additional aortic root pseudoaneurysm in four patients (8%), and sclero-degenerative change across one of occluder of aortic prosthesis as cause of PVL in another patient (2%) not detected by TEE. CT negated the presence of aortic root abscess in one patient (2%), negated the presence of PVL in another patient (2%) both were detected by TEE. CT diagnosed occluder malfunction in one patient (2%) and underlying cause in two patients (4%) both were not detected by TEE. CT diagnosed presence of aortic arch dissection in one patient (2%) with large aortic root pseudoaneurysm. CT showed minor diagnostic change in six patients (12%). CT showed better delineation of site and periannular extension of aortic root abscess in four patients (8%). CT showed better assessment severity of PVL in one patient (2%) and cause of PVL across mechanical aortic prosthesis in another patient (2%). CT resulted in change of treatment strategy in 14 patients (28%). This included surgical excision of additional aortic root abscess or aortic root pseudoaneurysm in four patients (8%), surgical removal of prosthesis for underlying pathology (vegetation, malfunction due to underlying thrombus or PVL) in four patients (8%), aortic arch replacement with tubular graft and reimplantation of coronaries in one patient (2%) and conservative treatment with antibiotic therapy for small aortic root abscess not detected by TEE in 2 patients (4%), proper anticoagulation therapy and close monitor of INR in one patient (2%). Conclusion ECG-gated CT and TEE are complementary in patients with prosthetic valve dysfunction. Therefore, CT imaging has to be considered after clinical routine workup and TEE in patients with a high suspicion on prosthetic valve dysfunction.
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Usui, Takami, Kazufumi Suzuki, Hiroshi Niinami, and Shuji Sakai. "Aortic dissection diagnosed on stroke computed tomography protocol: a case report." Journal of Medical Case Reports 15, no. 1 (2021). http://dx.doi.org/10.1186/s13256-021-02850-1.
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Abstract Background Aortic dissection is one of the causes of stroke. Because cerebral infarction with aortic dissection is a contraindication to intravenous recombinant tissue plasminogen activator (rt-PA) therapy, exclusion of aortic dissection is necessary prior to its administration. However, imaging takes time to provide a diagnosis, possibly causing delays in surgical treatment. Case presentation A 65-year-old Japanese female patient was transported to the hospital for a suspected stroke, with back pain and left upper and lower extremity palsy which occurred while eating. Upon arrival at the hospital, the left lower limb paralysis had improved, but the left upper limb paralysis remained. Right back pain had also developed. A plain head computed tomography (CT) scan performed 110 minutes after onset showed no acute bleeding or infarction. Subsequent CT perfusion (CTP) showed acute perfusion disturbance in the right hemisphere without infarction, known as ischemic penumbra. The four-dimensional maximum-intensity projection image reconstructed from CTP showed a delayed enhancement at the right internal carotid and right middle cerebral arteries compared to the contralateral side, suggesting a proximal vascular lesion. Contrast helical CT from the neck to abdomen revealed an acute aortic dissection of Stanford type A with false lumen patency. The dissection extended to the proximal right common carotid artery. The patient underwent an emergency total arch replacement and open stent graft. After recovering well, the patient was ambulatory upon discharge from the hospital. The combination of plain head CT, CTP, and helical CT scan from the neck to abdomen enabled us to evaluate for stroke and aortic dissection within a short amount of time, allowing for early therapeutic intervention. Conclusions When acute stroke is suspected due to neurological deficits, plain head CT is the first choice for imaging diagnosis. The addition of cervical CT angiography can reliably exclude stroke due to aortic dissection. CTP can identify ischemic penumbra, which cannot be diagnosed by plain head CT or diffusion-weighted magnetic resonance imaging. These combined stroke CT protocols helped us avoid missing an aortic dissection.
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Mbacké, Sarr El Hadj, Khaddra H, Manga Simon Joël, et al. "Aortic Dissection Involving a Right Retroesophagian Subclaviary Artery (LUSORIA) Associated with a Bi-Carotidian Trunk: About a Case at the National University Hospital Center of Fann (Sénégal)." Cardiology & Vascular Research 5, no. 6 (2021). http://dx.doi.org/10.33425/2639-8486.1128.
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The lusoria artery is a rare congenital vascular anomaly involving most of the time the right subclavian artery. It can also be associated with a serious vascular pathology such as aortic dissection although this phenomenon is not common in the literature and most often requires rather complex surgical management because of the layout of this artery. We report a discovery of a lusoria artery case revealed by aortic dissection. This is a 63-yearold patient with recently discovered hypertension as a cardiovascular risk factor. He was received for severe chest pain. Clinical examination found grade III systolo-diastolic hypertension and tachycardia. The thoracic CT angiography found an aspect of type B aortic dissection associated with an aberrant right subclavian artery of the lusoria type. In emergency, the patient had benefited from an antihypertensive treatment allowing stabilizing his high blood pressure. The development during hospitalization was favorable with a disappearance of the pain and a stabilization of his blood pressure levels. His discharge was made on D10 of hospitalization with a transfer to a cardiovascular surgery center for better treatment.