Residual Tears Research Articles

Impact of Residual Entry Tears in the Descending Aorta After Type A Dissection

BackgroundAggressive resection/exclusion of the primary entry in the descending aorta remains controversial in older patients with acute type A aortic dissection (ATAAD). We investigated the effect of residual primary entry in the descending aorta in younger and older groups. MethodsPatients with ATAAD who underwent emergency operation (n = 1103) were divided into younger (<70 years; n = 681) and older (≥70 years; n = 422) cohorts. Each cohort was further divided into groups with or without residual primary entry in the descending aorta. After propensity score matching, 179 and 71 matched pairs were obtained in the younger and older cohorts, respectively. Surgical outcomes were compared between the residual and nonresidual groups in each age cohort. ResultsIn the younger cohort, the cumulative incidence rate of distal aortic events was significantly higher in the residual than in the nonresidual group at 10 years (35% [95% CI, 27%-44%] vs 22% [95% CI, 15%-31%], P = .001). However, in the older group, residual or nonresidual primary entry did not affect the rates at 10 years (11% [95% CI, 5%-20%] vs 9% [95% CI, 4%-17%], P = .75). Multivariate analysis identified age <70 years (hazard ratio, 2.188; 95% CI, 1.493-3.205; P < .001) and residual primary entry at the descending aorta (hazard ratio, 2.142; 95% CI, 1.559-2.943; P < .001) as significant predictors for distal aortic events. ConclusionsAggressive resection/exclusion of the primary entry in the descending aorta should be considered for patients aged <70 years to avoid distal aortic events; however, it might not always be appropriate for the older patients ≥70 years.

A Novel Endovascular Double-Disc Implant for Sealing Intimal Tears in Aortic Dissection

Postdissection thoracoabdominal aortic aneurysm incidence after thoracic endovascular aortic repair for type B aortic dissection is high, with residual distal tears being a major reason for persistent blood flow in the false lumen. The EndoPatch is an endovascular double-disc implant for sealing re-entry tears in aortic dissection, isolating blood flow in the false lumen and promoting thrombosis formation. Compared with conventional endovascular treatment techniques, this endovascular double-disc implant’s small size and minimal working space requirements may reduce the risk of spinal ischemia and offer flexible vascular access. Although several barriers still impede this endovascular device’s broad application, its innovative design, flexible vascular access, and streamlined surgical process make it a promising alternative for managing intimal tears in aortic dissection, either alone or as a supplementary method combined with conventional endovascular techniques. (Guo’s Entry Tear Repair: The First in Man Study of Endopatch System; NCT04745039)

Early endovascular intervention for unfavorable remodeling of the thoracic aorta after open surgery for acute DeBakey type I aortic dissection: study protocol for a multicenter, randomized, controlled trial

BackgroundTotal arch replacement with frozen elephant trunk has been developed with promising results for DeBakey type I aortic dissection. However, several problems, such as continuous perfusion of distal false lumen and unfavorable remodeling of distal aorta postoperatively, can seriously affect the long-term outcome. This trial aims to assess the effects of early minimally invasive endovascular repair on distal aortic remodeling and long-term clinical outcomes in patients with dominant false lumen and residual tears in the descending thoracic aorta after total arch replacement and frozen elephant trunk procedure.MethodsThis is a protocol for a two-arm, parallel, multicenter, randomized controlled trial. A total of 154 eligible patients will be recruited from four hospitals in China and randomized on a 1:1 basis either to the experiment group (endovascular repair in addition to routine antihypertensive therapy) or the control group (routine antihypertensive therapy without early surgical treatment). The primary outcome will be the five-year all-cause mortality. The secondary outcomes will include re-intervention, ischemic symptoms, organ dysfunction, and stent-related adverse events.DiscussionIf early minimally invasive endovascular repair could safely and effectively promote distal aortic remodeling and bring favorable long-term outcomes for patients with dominant false lumen and residual tears in the descending thoracic aorta after total arch replacement and frozen elephant trunk technique, it would improve the treatment strategy for DeBakey type I aortic dissection.Trial registrationChinese Clinical Trial Registry, CHiCTR2000030050. Registered on 11 March 2020.

The relationship between the characteristics of tears and the progression of Stanford type B aortic dissection after endovascular treatment

Endovascular treatment of Stanford type B aortic dissection (type B dissection) has been widely used. There will be complications such as aortic dilatation, which will lead to poor prognosis of some patients. With more in-depth researches, it was found that there was a possible correlation between the prognosis of type B dissection and tears, such as the increasing of aortic diameter would be faster with longer tears, and the location of the tear will affect the thrombosis of the false lumen. Studies on hemodynamics have also found that different characteristics of tears of aortic dissection can cause changes in the pressure, blood flow rate and blood capacity in the true and false lumens recently. The hemodynamic changes can be used to predict the prognosis of type B dissection. The main characteristics of tears included the size, position, number of tears, residual tears and stent graft induced new entry. Describing the effect of tear characteristics on the development of type B dissection, can provide the basis for the clinical treatment and further research of type B dissection.

The risk factors of distal aorta negative remodeling after endovascular aortic repair in type B dissection

In recent years, great progress has been made in the treatment of Stanford type B aortic dissection, especially endovascular repair technology has become the main treatment. However, it is only used to repair the primary tear, the residual tears and false lumen are often left at the distal end, which causes adverse events such as distal aortic dilatation or even rupture. At present, there are many studies on the influencing factors of aortic remodeling, which provide some references for the prognosis of patients.The aorta carries the transportation of blood flow, and various factors affecting hemodynamics also affect the remodeling of aorta. Some researchers reported several factors related to negative remodeling and added auxiliary techniques, and achieved gratifying results. However, because of the different conditions of each patient, the specific treatment method is still unclear, the factors affecting the aortic remodeling effect also have not been thoroughly studied. Clarifying the influencing factors of negative remodeling is helpful to screen high-risk patients, optimize the treatment plan and improve the prognosis.

Effects of Residual Arch Tears on Late Outcomes After Hemiarch Replacement for DeBakey I Dissection

BackgroundThis study evaluated the effect of residual arch tears on late reinterventions and arch dilatation after hemiarch replacement for patients with acute DeBakey type I aortic dissection. MethodsBetween January 1995 and October 2018, 160 consecutive patients who underwent hemiarch replacement for DeBakey type I dissection were retrospectively enrolled. They were divided into patients with (n = 73) and without (n = 87) residual arch tears. The arch tears group was subdivided into the proximal/middle arch (n = 26) and distal arch (n = 47) groups to evaluate arch growth rates according to the locations of residual arch tears. The endpoints were arch growth rate and late arch and composite events. ResultsThe arch diameter increased significantly over time in patients with residual arch tears (1.620 mm/y, P < .001). The increase occurred more rapidly when residual tears occurred at the distal arch than at the proximal/middle arch level (2.101 vs 1.001 mm/y). In the adjusted linear mixed model, residual arch tears or luminal communications at the distal arch level were significant factors associated with increases in the arch diameter over time. The 10-year freedom from late arch and composite event rate was significantly lower for patients with residual arch tears than for those without (82.4% vs 95.5%, P = .001; and 68.0% vs 89.3%, P = .002, respectively). ConclusionsResidual arch tears are significant factors associated with late arch dilatation and reinterventions, especially for patients with distal arch tears. Extensive arch replacement during the initial surgery to avoid residual arch tears may improve long-term outcomes.

Long-Term Aortic Remodeling After Thoracic Endovascular Aortic Repair of Acute, Subacute, and Chronic Type B Dissections.

ObjectiveThis study aimed to investigate the characteristics and predictors of aortic remodeling over a long-term follow-up period after thoracic endovascular aortic repair (TEVAR) for acute, subacute, and chronic type B aortic dissections (TBADs).MethodsPatients who underwent TEVAR for TBAD from July 2011 to December 2013 were included, and relevant data were retrospectively analyzed.ResultsAfter TEVAR, the true lumen (TL) dimension increased and the false lumen (FL) dimension decreased or did not change over a 5-year follow-up period in all three temporal groups. Shrinkage proportion of the thoracic aorta was the highest in the subacute group (acute, 28.1%; subacute, 39.1%; and chronic, 17.4%; p = 0.048), while abdominal expansion showed no significant differences among the groups (acute, 29.6%; subacute, 40.5%; and chronic, 44.4%; p = 0.502). The chronic group had a rate of complete FL regression, which is lower than the subacute or acute group at all anatomic sections, with significant differences only in the stented section (chronic, 21.7%; acute, 92.2%; and subacute, 80.4%; p < 0.05) and in the distal thoracic aortic section (chronic, 13.0%; acute, 31.1%; and subacute, 50.0%; p < 0.05). Logistic regression analysis demonstrated that chronic dissection, TL compression, endoleak, the number of branches from FL, and the number of residual tears affected optimal FL remodeling.ConclusionThe present study provides data on aortic remodeling of TBAD after TEVAR during a long-term follow-up period. The features and risk factors of aortic remodeling in the acute, subacute, and chronic phases are different in different aortic segments. These findings may have implications in the timing of TEVAR.

Obstetrical forceps-induced Descemet membrane tears.

Obstetrical forceps-induced Descemet membrane tears (FIDMT) are usually encountered during complicated forceps-assisted deliveries. The condition may lead to significant visual debilitation in young children and is frequently ignored due to its low incidence. Undue stretch on the Descemet’s membrane during the process of forceps-assisted delivery results in their vertical/oblique tear (s), which usually leads to corneal edema in early neonatal life. On its resolution, these residual tears result in visually disabling astigmatism that can lead to dense and recalcitrant amblyopia. Slit-lamp examination, anterior segment optical coherence tomography, specular microscopy, confocal microscopy, and corneal topography and tomography can be employed for its accurate diagnosis. While these can be prevented by improved perinatal care, once diagnosed, they mandate prompt refractive correction and amblyopia therapy to prevent disabling visual deterioration in affected children. In adulthood, medical and surgical management may be planned for symptomatic patients based on coexistent amblyopia as this is the major factor guiding visual prognosis. There is limited comprehensive literature in this regard, and the present review discusses the pathogenesis, clinical features, and recent developments in investigations, management, and outcomes of FIDMT during the last three decades.

Analysis of factors influencing the remodeling of abdominal false lumen after thoracic aortic endovascular repair

Objective: To examine the factors influencing the false lumen remodeling of abdominal aortic segment in the midterm and longterm after thoracic endovascular aortic repair (TEVAR). Methods: The data of patients with type B aortic dissection diagnosed and underwent TEVAR at the Department of Vascular and Endovascular Surgery, the First Medical Center, People's Liberation Army General Hospital, from November 2009 to November 2019 were analyzed retrospectively. Patients of acute or subacute long segment dissection with residual tears of abdominal but no thoracic segment and follow-up for more than one year were enrolled. Patients with operation-related complications, and dissection caused by trauma and Marfan syndrome were excluded. A total of 51 patients were enrolled, including 45 males and 6 females, with an age of (49.4±10.6) years (range: 31 to 72 years). The patients included in the analysis were divided into stable and enlarged group. The criteria for inclusion in the enlarged group were any of the following: (1) the maximum growth rate of the abdominal segment false lumen was ≥3 mm/year; (2) the maximum diameter of the abdominal aorta was ≥50 mm; (3) the diameter of the abdominal segment false lumen increased more than 10 mm. χ2 test, t-test and nonparametric test were used for univariate analysis. The variables with P≤0.1 were included in the Logistic multivariate stepwise regression to analyze the independent correlation factors, and the receiver operating characteristic (ROC) curve was used to calculate the cut-off value of the quantitative data. Results: All patients were divided into stable group (n=30) and enlarged group (n=21). The follow-up time of all patients was 42(29) months (range: 12 to 115 months). There were no significant differences in baseline characteristics, endovascular treatment characteristics and postoperative medication between the two groups (P>0.05). Compared with stable group,the number of residual tears around visceral arteries was more (2(1) vs. 1(1), Z=-2.829, P=0.005) and the number of lumbar arteries originating from false lumen was more (5(6) vs. 3(5), Z=-2.025, P=0.043) early after TEVAR in enlarged group. The number of residual tears around visceral arteries (OR=3.966, 95%CI: 1.552 to 10.131, P=0.004) was found to be the independent influence factor for the poor remodeling of the abdominal false lumen in multivariate Logistic regression analysis. ROC curve analysis showed that the cut-off value of the number of residual tears around visceral arteries was 2 at least (area under curve: 0.718). Conclusion: The incidence of poor remodeling of the abdominal false lumen after TEVAR was high. The number of residual tears around visceral arteries (≥2) could be independent influence factor to predict the poor remodeling of abdominal false lumen, and the follow-up of such patients should be strengthened in clinic.

Influence of Distal Re-entry Tears on False Lumen Thrombosis After Thoracic Endovascular Aortic Repair in Type B Aortic Dissection Patients: A Computational Fluid Dynamics Simulation.

Distal re-entry tears play a significant role in false lumen (FL) thrombosis, which will strongly affect the postoperative long-term survival of patients with type B aortic dissection (TBAD) after thoracic endovascular aortic repair (TEVAR). This study aimed to investigate the influence of a peculiar morphological parameter of the residual re-entry tears in TBAD patients after TEVAR on long-term FL thrombosis using the computational fluid dynamics. Ideal population-based three-dimensional models of post-operative TBAD were established. Numerical simulation was performed to investigate the hemodynamic differences caused by different tear features, including the tear count, the maximum distance between tears, and the tear area. Although the low relative residence time (RRT) area did not change significantly when the tear distance was fixed, the area of oscillatory shear index (OSI) > 0.45 and endothelial cell activation potential (ECAP) > 1.5 decreased significantly with the tear count and area increased and a dramatic increase in blood flow into the FL was also observed. When tear count and total area were fixed, for each 10-mm increase in the maximum distance between tears, the area of low RRT in the FL increased significantly, while the average pressure difference increased by 10.85%. The different morphology of the re-entry tears had different effects on the thrombosis-related hemodynamic parameters in FL following TEVAR. and the number of re-entry tears was most crucial to the potential thrombosis in the post-TEVAR FL of TBAD patients.

Sudden Chest Pain Due to Esophageal Intramural Dissection

Sudden Chest Pain Due to Esophageal Intramural Dissection

Successful Revision Arthroscopic Rotator Cuff Repair Is Possible in the Setting of Prior Deep Infection

PurposeTo report on clinical outcomes of revision arthroscopic rotator cuff (RC) repair in the setting of prior deep infection.MethodsA retrospective review was conducted of a single surgeon’s experience treating patients with deep infection after RC repair. Pain by visual analog scale (VAS), American Shoulder Elbow Society (ASES), Simple Shoulder Test (SST), and Single Assessment Numeric Evaluation (SANE) scores, as well as active range of motion, were collected preoperatively and at final follow-up.ResultsThree patients age 54.0 ± 7.5 years, mean ± standard error of the mean) with mean follow-up of 62 months (range 24 to 83) were treated for deep infection after RC repair. Improvements were observed in all subjective and objective outcomes; VAS pain (5.0 ± 0.6 vs 0.3 ± 0.3, P = .005), ASES score (37.2 ± 4.0 vs 93.9 ± 6.1, P = .003), and active forward elevation (68.3° ± 28.5° vs 173.3° ± 6.7°, P = .06.) Excellent outcomes in SST (mean 11.3 ± 0.7) and SANE (95.0 ± 5.0) scores were also observed. No recurrent infections were noted at final follow-up.ConclusionArthroscopic reconstruction of the RC is a feasible goal in the setting of prior deep infection. When a thorough arthroscopic debridement can be achieved, it is possible to address residual RC tears with either revision repair or allograft reconstruction with the possibility of excellent short-term clinical outcomes.Level of EvidenceLevel IV, retrospective case series

Risk factors of distal segment aortic enlargement after complicated type B aortic dissection

ObjectivesDistal segment aortic enlargement (DSAE) is a common complication that influences the long-term prognosis of type B aortic dissection (TBAD) after thoracic endovascular aortic repair (TEVAR). In this study, a multivariate analysis was performed to find potential factors predictive of DSAE. MethodsA single-center retrospective study was performed from 1999 to 2016. Included in the study were complicated TBAD patients who underwent TEVAR with uncovered residual tears. Based on the diameter of the distal segment of the uncovered aorta, we assigned patients to an enlargement group and a non-enlargement group. Data extracted from the medical records included demographic and clinical characteristics and follow-up computed tomography angiography data. The primary endpoints were the all-cause mortality and the presumably aortic-related events that required reintervention during the follow-up period. ResultsFor the 333 patients, all-cause mortality was 38 (11.41%), and 76 (22.82%) patients underwent reintervention. A total of 70 (21.02%) patients experienced DSAE, among them were 2 patients who died of aortic rupture and 58 patients who accepted reintervention. Multivariate analysis reviewed independent risk factors of postoperative DSAE, including current smoking, the residual length of the patent false lumen, the postoperative number of dissection tears in the thoracic aorta and type III aortic arch; as well as protective factors, including the application of a restrictive bare stent (RBS), the length of covered stent in the descending thoracic aorta, and the distance from the residual first tear to the left subclavian artery (LSA). ConclusionDSAE after TEVAR for patients with a complicated TBAD can be influenced by their current smoking habit, the residual length of patent false lumen, the postoperative number of dissection tears in the thoracic aorta and the aortic arch type. Meanwhile, RBS usage, the length of the covered stent in the descending thoracic aorta and the distance from the residual first tear to the LSA could have positive effect on the prognosis.

Long-term outcomes of balloon-expandable bare stent as chimney stent in thoracic endovascular aortic repair for supra-aortic branches reconstruction.

To report the long-term outcomes of balloon-expandable bare stent (BEBS) as chimney stent (CS) in thoracic endovascular aortic repair (TEVAR) for supra-aortic branches reconstruction. A total of 33 patients with thoracic aortic diseases underwent TEVAR using BEBSs as CSs for supra-aortic branches reconstruction in our center from 2010 to 2015. The demographics and procedural details were prospectively collected and retrospectively reviewed. All patients were followed up at 1, 3, 6 months and every 1 year thereafter. Postoperative complications and long-term outcomes were recorded. The technical success rate was 100%. A total of 36 BEBSs were utilized as CSs to reconstruct the supra-aortic branches during TEVAR. The rate of immediate endoleak was 42.4% (14/33), including 12 (36.4%) type Ia endoleaks and 2 (6.1%) type II endoleaks. Two of type Ia endoleaks were managed by balloon dilation and disappeared, while the rest were left with close follow-up. Two type II endoleaks were embolized by coils and excluded by a plug, respectively. One patient (3.0%) died 2 days after the procedure due to the acute rupture of aortic dissection. The mean follow-up time was 61.8 (ranged from 12 to 102) months. The unmanaged 10 type Ia endoleaks were closely observed during the follow-up, of which 7 disappeared at 1 year and 1 disappeared at 2 years. The rest 2 type Ia endoleaks existed without further dilation of the aorta. One patient (3.0%) was re-intervened for the increased false lumen due to the distal residual tears. The long-term mortality was 9.1% (3/33). All CSs kept patent till the end of follow-up. No other complications were found. The balloon-expandable stent (BES) is a feasible choice as CS for supra-aortic branches reconstruction with long-term patency during TEVAR. However, BEBS may be related to a higher rate of early endoleak.

Complete Thoracic Aorta Remodeling After Endovascular Aortic Repair: A New Therapeutic Goal for Chronic DeBakey IIIb Aneurysms

To introduce complete thoracic aorta remodeling as a new therapeutic target of thoracic endovascular aortic repair for chronic DeBakey IIIb aneurysms, and analyze the predictors for complete thoracic aorta remodeling. From 2012 to 2017, 75 patients underwent thoracic endovascular aortic repair for chronic DeBakey IIIb aneurysms. Complete thoracic aorta remodeling was defined as thoracic false lumen thrombosis with false lumen diameter <5 mm down to T-10 level. Major adverse aortic events were defined as aortic-related mortality, open conversion, and false lumen recanalization after thoracic false lumen thrombosis. Of the 75 patients included in this study, 60 (80.0%) demonstrated thoracic false lumen thrombosis; among them, overall mortality, open conversion, or false lumen recanalization after thoracic false lumen thrombosis occurred in two (3.3%), one (1.7%), and five (8.3%) patients, respectively. Nineteen (25.3%) of 75 patients who demonstrated complete thoracic aorta remodeling had no major adverse aortic events during follow-up. The number of visceral branches from the false lumen and residual intima tears were significant risk factors for complete thoracic aorta remodeling (HR 0.627, p = 0.041 and HR 0.754, p = 0.042). In chronic DeBakey IIIb aneurysms, complete thoracic aorta remodeling may be the ideal target for endovascular treatment rather than false lumen thrombosis. Additional procedures to eliminate the obstacles to complete thoracic aorta remodeling (number of visceral branches from the false lumen and residual intimal tears) and close follow-up after thoracic false lumen thrombosis may be needed to achieve the optimal outcome.

Selection of surgical intervention for congenital dacryocystocele.

To evaluate the surgical intervention and its effect on congenital dacryocystocele. A total of 531 children with congenital dacryocystocele admitted to the Department of Ophthalmology of Beijing Children's Hospital, Shanghai Aier Eye Hospital, Nanjing Aier Eye Hospital, and the First Affiliated Hospital of Jinzhou Medical University between January 2007 and January 2017 were retrospectively analyzed. A total of 531 patients were followed up for 3-24 months, with an average of 13.3 months. No serious intraoperative complications (such as bleeding and tissue damage) and postoperative complications (bleeding, infection, and hole atresia) were found. We classified the outcomes into three categories based on the signs (overflowing tears and empyema) and objective routine follow-up by endoscopy. Cure indicated that mass, overflow of tears, and breathing difficulties disappeared, and 81.5% cases (433/531) were postoperatively cured. Improvement indicated disappearance of mass, overflow empyema, and the presence of residual tears (due to trocar and tears puncture), and 18.5% cases (98/531) were postoperatively improved. Unhealed indicated overflowing pus and tears, and 0% cases did not heal after surgery. Nasal endoscopic surgery is relatively safe, with high success rate for treatment of congenital dacryocystocele. Systematic training is required to promote the application of nasal endoscopy, so that more ophthalmologists can learn this technique.

Residual Arch Tears and Major Adverse Events After Acute DeBakey Type I Aortic Dissection Repair

Tear-oriented surgical procedure is considered a standard treatment for acute DeBakey type I aortic dissection (AIAD). However, long-term surgical outcomes, including aortic growth and rate of major adverse aortic events (MAAEs), have yet to be clarified. Of the 274 patients who underwent surgical repair for AIAD between 2009 and 2016, 105 patients with both predischarge and follow-up computed tomographic scans were enrolled. The surgical extent was determined by primary entry tear location. We measured aortic diameters (pulmonary artery bifurcation, maximum diameter of the descending thoracic aorta [maxDTA], andceliac axis) and compared MAAEs (aorta growth rate ≥ 5 mm/year or maxDTA ≥ 55 mm according to surgical extent). Twenty-nine patients underwent total arch replacement (TAR); 76 underwent non-TAR. In the non-TAR group, patients with or without residual tears in the arch vessels were classified as having complete arch repair (non-TAR-CAR, n= 52) or incomplete arch repair (non-TAR-IAR, n= 24). Considerable differences were found in the aortic growth rate between the TAR and non-TAR groups and the non-TAR-CAR and non-TAR-IAR groups. Freedom from MAAEs at 5 years was considerably higher in the non-TAR-CAR group than in the non-TAR-IAR group (84.5% versus 31.1%). However, no differences were observed in the aortic growth rate and freedom from MAAEs between the TAR and non-TAR-CAR groups. Classic tear-oriented surgical procedure is insufficient for optimal long-term surgical outcomes, mainly regarding aortic dilation. CAR without residual arch vessel tears leads to favorable aortic remodeling in the residual DTA and prevents MAAEs after AIAD repair.

The fate of the abdominal aorta after endovascular treatment in chronic Debakey IIIb aneurysm

ObjectivesWe sought to identify the risk factors for abdominal aortic remodeling after thoracic endovascular aortic repair in patients with chronic DeBakey IIIb aneurysm. MethodsFrom 2012 to 2016, 70 patients underwent thoracic endovascular aortic repair for chronic DeBakey IIIb aneurysm. The abdominal aortic diameter was measured at 3 different levels (celiac trunk, renal artery, and infrarenal aorta). Abdominal aorta status was classified as expansion or stable. Expansion status was assigned when the abdominal aortic diameter was increased over 5 mm at least 1 level. Otherwise, it was classified as stable status. Forty-six of 70 patients underwent more than 2 postoperative imaging studies. In those patients (n = 46), abdominal aortic volume was measured from celiac trunk to inferior mesenteric artery. A linear mixed-effect model was used to analyze the overall fate of abdominal aortic volume. ResultsNo in-hospital mortality occurred. The mean follow-up and imaging follow-up duration were 26 and 17 months, respectively. Sixty-one patients (87.1%) demonstrated thoracic false-lumen thrombosis. Although false-lumen thrombosis was achieved, 15 patients (24.6%) demonstrated the expansion status. In volumetric analysis, the total abdominal aortic volume was increasing over time (0.603 cm3/mo; P < .001) and the residual intima tears were identified as an independent anatomic risk factor for an enlarged abdominal aorta. ConclusionsAn enlarged abdominal aorta in chronic DeBakey IIIb aneurysm can be frequently recognized even after successful endovascular treatment. The residual intima tears were the only identified risk factor for change in a dissected abdominal aneurysm. We suggest careful abdominal aorta evaluation and additional procedures on the false lumen if necessary.

Arthroscopic Hip Surgery: Frequency of Postoperative MR Arthrographic Findings in Asymptomatic and Symptomatic Patients.

Purpose To determine and compare the frequency of imaging abnormalities in asymptomatic and symptomatic patients after arthroscopic hip surgery. Materials and Methods This study was approved by the institutional review board. Informed consent was obtained from all patients. Thirty-four patients (17 asymptomatic and 17 symptomatic patients) underwent 1.5-T magnetic resonance (MR) arthrography of the hip 1 year after arthroscopic treatment of femoroacetabular impingement. Two readers independently analyzed all MR arthrographic images for the presence of abnormal imaging findings, including capsular adhesions at the femoral neck, obliteration of the paralabral sulcus, labral defects, and defects of the hip capsule in several anatomic positions (anterior to posterior). Postoperative findings were compared with linear and generalized linear mixed-effects regression models. Results Capsular adhesions at the anterior femoral neck were present in 12 of the 34 patients (35%), and there were no differences between the groups or readers (P = .99). The paralabral sulcus was obliterated in at least one anatomic location in 94% (reader 1, 32 of 34 patients) and 100% (reader 2, 34 of 34 patients) of patients (P = .99). Residual labral tears were detected in 35% of asymptomatic patients (six of 17 patients) and 41% of symptomatic patients (seven of 17 patients) by reader 1 and in 53% of asymptomatic and symptomatic patients (nine of 17 patients in each group) by reader 2, without significant differences between the groups (P = .81). Defects of the hip capsule were more common in asymptomatic patients (77% [13 of 17 patients] for reader 1 and 53% [nine of 17 patients] for reader 2) than in symptomatic patients (59% [10 of 17 patients] for reader 1 and 47% [eight of 17 patients] for reader 2), but without significant differences (P = .33). Conclusion Obliteration of the paralabral sulcus was the most frequent finding after arthroscopic hip surgery in both asymptomatic and symptomatic patients, and capsular adhesions at the anterior femoral neck were present in 35% of patients in both groups. © RSNA, 2016.

Percutaneous medial collateral ligament release in arthroscopic medial meniscectomy in tight knees

Visualization and surgery of tears in the posterior medial meniscus are difficult in tight knees. Iatrogenic chondral lesions might cause serious morbidity, and residual tears may result in inadequate symptom relief. We evaluated the clinical and radiological results of superficial medial collateral ligament (MCL) release during arthroscopic medial meniscectomy in tight knees. Eighteen patients [median age: 43 years (22-59); median follow-up: 8.3 months (6-12)] who underwent arthroscopic meniscectomy were included in the study. Patients with ligamentous injuries, severe chondral damage or meniscal repairs were excluded. Preoperatively, anteroposterior knee radiographs were obtained with 11-kg valgus stress using a specialized instrument. During the operation, if opening of the medial knee in 30° flexion under 11-kg valgus stress was inadequate, controlled release of the posterior portion of the MCL was performed using a 16-gauge needle. Intraoperative valgus stress was monitored using a specially designed lateral support with mounted load cell. MCL injury was evaluated both with magnetic resonance imaging (MRI) and valgus stress radiographs, which were obtained in the 1st week and 3rd and 6th months postoperatively to monitor healing of the elongated MCL. In all patients, meniscectomy could be performed with adequate visualization of the posterior medial meniscus and without iatrogenic chondral injury. The median medial joint space width on valgus stress radiographs was 7.1 mm preoperatively and 9.1, 8.0 and 7.2 mm in the 1st week, and 3rd and 6th months, respectively (p < 0.0001). On MRI, the injured structure was the posterior two-thirds of the MCL. Median Lysholm score, which was 42 points before the operation, had increased to 94 points at the final follow-up (p = 0.0002). Controlled release of the MCL in tight knees allowed easier handling in posterior medial meniscus tears and a better understanding of tear configurations, avoiding iatrogenic chondral lesions. The MCL injury healed uneventfully. IV.