Rupture Of Aortic Arch Aneurysm Research Articles

An Older Adult of Acute Aortic Arch Aneurysm Rupture, Presented as Ecchymosis, Neck Swelling, and Sensation of Foreign Body in the Throat: A Case Report

<p>急性胸部主動脈瘤破裂是一種不常見卻會危及生命的事件，發生率是每十萬個人中有3.5個人。而主動脈弓是胸部主動脈的一部分，發生在這個部位的動脈瘤破裂之發生率和自然病程仍然還沒有被研究透徹。我們在這一份文章中將會介紹一個85歲的男性病人發生胸部主動脈弓動脈瘤破裂的急性狀況，一開始他曾到基層診所就醫，然而除了身體檢查發現脖子腫和皮膚瘀青，生理徵象和鼻咽內視鏡卻沒有異常發現。這一篇文章的目的是希望可以提高臨床工作者在臨床上遇到此類少見疾病時即時的鑑別診斷，並把握可以治療的機會。</p> <p> </p><p>Acute thoracic aortic aneurysm rupture is an uncommon life-threatening event, found in 3.5 per 100,000 individuals. Aortic arch is one part of the thoracic aorta. The true incidence and natural course of an isolated aortic arch aneurysm are still relatively unknown. Here we report a case of acute thoracic aortic arch aneurysm rupture, in an 85-year-old male, initially ecchymosis and mild neck swelling were noticed by physical examination, but no abnormality was found in vital signs even through nasopharyngeal endoscopy. The purpose behind this paper is to raise clinical suspicion regarding this rare pathology, so that well-timed diagnosis and management can be carried out.</p> <p> </p>

Pulmonary Artery Occlusion Due to Abrupt Pinhole Rupture of Aortic Arch Aneurysm

Pulmonary Artery Occlusion Due to Abrupt Pinhole Rupture of Aortic Arch Aneurysm

Survival after endovascular therapy in patients with ruptured thoracic aortic diseases: Results from the Global Registry for Endovascular Aortic Treatment Registry

ObjectiveThe Global Registry for Endovascular Aortic Treatment is a prospective observational multicenter cohort registry of all Gore aortic endografts for a variety of aortic pathologies. The purpose of this study was to evaluate the outcome of the Conformable GORE TAG Thoracic Endoprosthesis and GORE TAG Thoracic Endoprosthesis devices for ruptured thoracic aortic syndromes. MethodsBetween December 2010 and October 2016, a total of 5018 patients were enrolled from 114 international sites in this registry. The database was queried for patients with at least one of the following pathologies: descending thoracic aortic aneurysm with rupture, thoracoabdominal aortic aneurysm rupture, descending aortic dissection rupture, and aortic arch aneurysm rupture. Patient demographics, operative details, and clinical outcomes were analyzed. ResultsA total of 40 patients were treated with a ruptured thoracic aortic disease (62.5% male; mean age, 67.5 ± 14.1 years). Nineteen patients were treated for descending thoracic aneurysm rupture, 9 for thoracoabdominal aneurysm rupture, 7 for descending aortic dissection rupture, and 5 for aortic arch aneurysm rupture. Technical success was achieved in 40 of 40 patients (100%). There were no intraoperative mortalities and no conversions to an open procedure. A total of 12 patients (30.0%) required intervention for involvement of at least one aortic branch vessel (4 covered, 5 surgically debranched, 1 stented, and 6 chimney technique). The 30-day mortality was four patients (10.0%). Early reintervention (≤30 days) was required in seven patients (17.5%), five of which were device related. There was a total of five endoleaks and all five required a reintervention. The median follow-up duration was 14.7 months (range, 1-57 months). Freedom from device-related intervention at 1 year was 87.1% (95% confidence interval, [CI], 0.716-0.944), at 2 years was 81.3% (95% CI 0.607-0.917) and at 3 years was 73.1% (95% CI, 0.47-0.878). Freedom from all-cause mortality at 1 year was 65.0% (95% CI, 0.474-0.780), at 2 years was 61.2% (95% CI, 0.431-0.751), and at 3 years was 56.1% (95% CI, 0.369-0.715). ConclusionsThe Conformable GORE TAG Thoracic Endoprosthesis and GORE TAG Thoracic Endoprosthesis thoracic endografts provide an effective treatment for ruptured thoracic aortic diseases. Adjunctive coverage or revascularization of an aortic branch vessel may be necessary. Longer follow-up and larger studies are needed to determine durability of these repairs.

Distalization of left subclavian artery for cerebral revascularization during hybrid repair of complex and contained rupture of aortic arch aneurysm

A ruptured aortic arch aneurysm is imminently fatal unless expeditiously intervened. Hybrid thoracic endovascular aneurysm repair has revolutionized the therapeutic paradigm, in a complex clinical setting, in particular, compared to demanding and particularly riskier open reconstruction with its attendant cardiac and neurological sequelae. Herein, we describe a 52-year-old male who presented with a ruptured aortic arch aneurysm and concomitant innominate artery aneurysm with occluded left common carotid artery (CCA). Computed tomography (CT) aortogram visualized large retrosternal hematoma precluding sternotomy without circulatory arrest and distal end of aneurysm abutting ostium of theleft subclavian artery (LSA). Therefore, staged reimplantation of LSA to descending thoracic aorta (DTA) and extra-anatomic LSA to right CCA bypass were performed through posterolateral thoracotomy followed by Zone 0 deployment of the aortic stent graft. The patient keeps good health and remains asymptomatic at 2 years of follow-up. Repeated CT aortogram done immediate postoperatively and at 13 months showed patent graft and no endoleak. Hybrid arch repair by supra-aortic debranching facilitated by distalized LSA on DTA is a viable therapeutic option in patients with complex arch and innominate artery aneurysms that mandate Zone 0 coverage during endovascular aneurysm repair.

Hybrid Repair of Ruptured Arch Aneurysm Without Sternotomy Through an Unusual Extraanatomic Bypass

A 42-year-old man experienced a complex aortic arch aneurysm rupture. He had previously undergone an operation for type A dissection and had extremely poor cardiac performance as well as deep sternal infection after the first procedure. The conventional open repair was considered to be a high risk for this patient. We therefore performed an alternative hybrid aortic procedure. The supraarch vessels were perfused through an extraanatomic bypass from an unusual and remote route, namely, the abdominal aorta. Then, stent grafts were implanted in the previously replaced aortic prostheses toexclude the aortic aneurysm. The patient recovered uneventfully with no neurologic adverse events.

A case of ruptured aortic arch aneurysm successfully treated by thoracic endovascular aneurysm repair with chimney graft.

We report the case of aortic arch aneurysm rupture treated successfully with thoracic endovascular aneurysm repair (TEVAR) accompanied by aortic arch debranching using the chimney graft technique. A 94-year-old man was transported to the hospital after complaining of chest pain for one day. Contrast-enhanced computed tomographic (CT) images revealed an aortic arch aneurysm rupture. Considering the patient's age and postoperative activities of daily living, TEVAR was used. In order to place an indwelling stent graft from the ascending aorta to the periphery, the chimney graft technique was used to debranch the brachiocephalic artery. Hemodynamics was stabilized postsurgically. Plain CT performed 20 days postoperatively confirmed that the intrathoracic hematoma had decreased in size. Although respiratory failure was persistent, there were improvements and the patient was extubated 34 days postoperatively and discharged from the intensive care unit 37 days postoperatively. On postoperative day 75, he was discharged from the hospital to an elder care facility. Few reports have focused on stent grafting for treating aortic arch aneurysm rupture. TEVAR using the chimney graft technique could be an effective treatment option for patients with a decreased ability to tolerate surgery.

Ruptured hemiarch and descending thoracic aorta aneurysm: hybrid treatment

Ruptured aortic arch aneurysm is a life threatening disease. Surgical repair has an high perioperative mortality rate and totally endovascular treatment is a challenge. Hybrid repair has been proposed as a valuable approach. We report the case of a patient with a contained rupture of aortic arch aneurysm. We treated him with a debranching of supraortic vessels with carotid-carotid and carotid-subclavian bypass and deployment of two enodgrafts in two different times. We consider hybrid treatment for arch and hemiarch a feasible option for aortic arch aneurysms in non emergent and in an emergency setting with an improvement in perioperative morbidity and mortality.

Ruptured aortic arch aneurysm: transposition of aortic arch branches after insertion of thoracic endovascular stent with extra-anatomic brain perfusion

Conventional surgical treatment of a ruptured aortic arch aneurysm is a challenging approach with a high rate of adverse outcomes. The midsternotomy can be complicated by total aortic disruption with often fatal massive hemorrhage. A preliminary cardiopulmonary bypass with peripheral cannulation and cooling is often preferred. Endovascular stents have been used in patients with thoraco-abdominal aneurysms, with good results. Its lone utilization for rupture of aortic arch aneurysm is not feasible because of the unavoidable occlusion of cerebral vessels' origins. A previous aorto-bicarotid bypass is mandatory and it requires the midsternotomy. Hence, we developed a combined technique. We performed a hybrid approach in a 74-year-old patient, affected by an aortic arch aneurysm, ruptured in its antero-inferior portion. First we ensured brain perfusion with a temporary surgical extra-anatomic (femoral-bicarotid) bypass. Then an endovascular stent graft was expanded from the distal portion of ascending aorta to the proximal one of the thoracic aorta, thus excluding the ruptured portion of the aortic arch. Then the patient underwent the definitive aorto-carotid bypass. This specific combined technique allows the complete treatment of a ruptured arch aneurysm, lowering the risks connected with sternothomic approach, mainly with previous cardiopulmonary bypass and deep hypothermic circulatory arrest.

Successful treatment of aSalmonella aortic arch aneurysm

A 52-year-old man hospitalized for hoarseness and chest pain was found in chest computed tomography to have an impending aortic arch aneurysm rupture. Laboratory studies showed the presence of severe inflammation. Based on a clinical diagnosis of infected aortic arch aneurysm, we conducted total arch replacement. Salmonella was identified in the aneurismal wall and antibiotics were administered long-term. The postoperative course was uneventful. The patient was discharged on postoperative day 48. He has remained afebrile and asymptomatic in the 10 months since surgery but continues to take 300 mg/d of oral levofloxacin.