Treatment Of Aortic Disease Research Articles

Combined Endovascular and Endoscopic Management of a Secondary Aortoesophageal Fistula after Open Surgical Aortic Repair in a Giant Descending Thoracic Aortic Pseudoaneurysm: Case Report and Review of Literature.

Secondary aortoesophageal fistula (AEF) is defined as a communication between the aorta and the esophagus, occurring after aortic disease treatment or esophageal procedures, associating very high mortality rates with treatment and being fatal without it. Several treatment strategies have been described in the literature, combining open surgery or endovascular aortic repair with surgical or endoscopic management of the esophageal lesion. We present the case of a 53-year-old patient with a history of open aortic surgery for a giant descending thoracic aortic pseudoaneurysm complicated with secondary AEF, successfully managed using emergency transiliac TEVAR (thoracic endovascular aortic repair), extensive antibiotic therapy associated with nutritional replenishment, and rehabilitation therapy. Novel endovascular and endoscopic devices have been developed, offering less invasive treatment strategies with improved outcomes, especially for high risk surgical patients. This case highlights the importance of a multidisciplinary approach to personalized medicine to manage such complex situations.

Early results of endovascular treatment for aortic diseases at Dong Nai General Hospital

Introduction: Aortic disease is a serious disease with sudden onset and high mortality. Endovascular intervention is a novel, minimally invasive method with good early and mid-term results.
 Subjects: We report 03 patients diagnosed with aortic disease undergoing endovascular intervention at Dong Nai general hospital.
 Results: 1 case of high-risk type B aortic dissection, 1 case of descending thoracic aortic aneurysm ruptured into the left lung causing hemoptysis and 1 case of symptomatic aortic arch aneurysm. 2 partial debranching of the aortic arch were performed. The recovery time of all 3 cases was 1 day. In the postoperative period, the patients quickly recovered and received physical therapy very soon. After the surgery, all patients recovered well and were able to integrate into daily life.
 Conclusion: Aortic endovascular intervention was successfully implemented at Dong Nai General Hospital in the initial phase. The availability of this technique at provincial hospitals improves prognosis, reduces mortality and complications, and contributes to the improvement of the hospital's professional quality.

Evaluation of aortic biomechanics in patients with aortic disease via imaging: A review.

As a bridge between the heart and the arteries, the aorta plays an important role in the cardiovascular system. The morbidity and mortality of aortic disease are extremely high, which is a serious threat to human life. The biomechanical abnormality of the aorta is an important factor of a series of pathological changes in the aortic wall. At present, there are many imaging methods to evaluate the biomechanics of the aorta, which will benefit to the early diagnosis and treatment of aortic disease. In this review, we describe the application of various imaging methods and parameters in aortic disease.

Computed Tomography Imaging of Aortic Dissections with Endovascular Treatment Considerations.

In the present review, we discuss the role of CT imaging in the management of aortic dissection, with a particular emphasis on endovascular treatment considerations. Computed tomography imaging is a fundamental tool in the diagnosis and management of acute and chronic aortic dissection. Its diagnostic accuracy and high resolution contribute to and guide operative strategy. Persistent high mortality for patients who develop aortic dissections suggests a need for innovative diagnostic and treatment strategies. In the recent era, considerable advances have been made in computed tomography (CT) image acquisition, processing, and analysis as well as endovascular technologies with expanded roles in the treatment of aortic diseases.

Aortic aneurysms and dissections: Unmet needs from physicians and engineers perspectives

The treatment of aortic disease is complex, requiring cardiothoracic and vascular surgeons to make pre-, post- and intraoperative decisions directly influencing patient survival and well-being. Despite tremendous advancement in vascular surgery and endovascular techniques in the last two decades, along with the abundance of research in the field, many unmet needs and unanswered questions remain. Tight collaboration between engineers and physicians is a keystone in translating new tools, techniques, and devices into practice. Here, we have gathered our perspective, as physicians and engineers, in several pressing issues associated with the diagnosis and treatment of aortic aneurysms and dissection, referring to the current knowledge and practice, signifying unmet needs as well as future directions.

Cardiac and Vascular Surgeons for the Treatment of Aortic Disease: A Successful Partnership for Decision-Making and Management of Complex Cases

Traditionally, cardiac and vascular surgeons have been treating diseases of the aorta as individual specialists. Neither cardiac nor vascular surgeons have ever considered the aorta as a whole, which can be diseased throughout its length at the same time requiring a more thoughtful and different approach. Aortic dissection and aneurysmal disease may well benefit from a multidisciplinary approach. In the context of this review, we discuss examples of joint operating between cardiac and vascular surgeons that may well become a more routine approach in more units in the future.

Modeling aortic diseases using induced pluripotent stem cells.

Induced pluripotent stem cells (iPSCs) offer an effective platform for studies of human physiology and have revealed new possibilities for disease modeling at the cellular level. These cells also have the potential to be leveraged in the practice of precision medicine, including personalized drug testing. Aortic diseases result in significant morbidity and mortality and pose a global burden to healthcare. Their pathogenesis is mostly associated with functional alterations of vascular components, such as endothelial cells and vascular smooth muscle cells. Drugs that have been proven to be effective in animal models often fail to protect patients from adverse aortic events in clinical studies, provoking researchers to develop reliable in vitro models using human cells. In this review, we summarize the patient iPSC‐derived aortic cells that have been utilized to model aortic diseases in vitro. In advanced models, hemodynamic factors, such as blood flow‐induced shear stress and cyclic strain, have been added to the systems to replicate cellular microenvironments in the aortic wall. Examples of the utility of such factors in modeling various aortopathies, such as Marfan syndrome, Loeys‐Dietz syndrome, and bicuspid aortic valve‐related aortopathy, are also described. Overall, the iPSC‐based in vitro cell models have shown the potential to promote the development and practice of precision medicine in the treatment of aortic diseases.

Thoracic aortic surgery: status and upcoming novelties.

Several novel technological developments and surgical approaches have characterized the field of aortic surgery in the recent decade. The progressive introduction of endovascular procedures, minimally invasive surgical techniques and hybrid approaches have changed the practice in aortic surgery and generated new trends and questions. Also, the advancements in the manufacturing of tissue engineered vascular grafts as substitutes for aortic replacements are enlightening new avenues in the treatment of aortic disease. This review will provide an overview of the current novel perspectives, debates and trends in major thoracic aortic surgery.

Elongation of the Aorta after Thoracic Endovascular Aortic Repair: A longitudinal study.

Aortic morphology is associated with age, with the diameter being larger in older people. Thoracic endovascular aortic repair (TEVAR) is a treatment for aortic diseases, such as aortic dissection. When evaluating patients, aortic elongation could interfere with the classification of TEVAR complications. The longitudinal change in aortic length has not been studied in detail. In patients receiving thoracic endovascular aortic repair between 2007 and 2013, we determined the aortic length between the sinotubular junction, left common carotid artery, subclavian artery, and celiac artery on their first five annual follow-up computed tomography (CT) exams. Using the immediate post-TEVAR follow-up CT as the comparison reference and a lengthening of the aortic segment by 10 mm or more as the definition of elongation, 16 of 41 (39%) showed elongation between the innominate artery and celiac artery. When compared with the immediate follow-up CT, a higher proportion of patients showed elongation at the fifth year’s follow-up CT than the first year’s follow-up CT (p < 0.01), and the average lengthening per year was 1.7 mm. There was progressive lengthening of the aorta after TEVAR.

Standards of reporting in open and endovascular aortic surgery (STORAGE guidelines).

The number of patients undergoing surgery on the thoracic and thoraco-abdominal aorta has been steadily increasing over the past decade. This document aims to give guidance to authors reporting on results in aortic surgery by clarifying definitions of aortic pathologies, open and endovascular techniques and by listing clinical parameters that should be provided for full presentation of patients' clinical profile and in particular, their outcome. The aim is to help find a common language in the treatment of aortic disease and to contribute to a better understanding of this patient population.

Hybrid treatment of an unusual traumatic aortic arch rupture with pseudoaneurysm: a case report

BackgroundTraumatic aortic arch rupture with pseudoaneurysm is a rare high fatal injury. Thoracic endovascular aortic repair(TEVAR) is widely used in the treatment of aortic diseases. However a unified traumatic aortic injury risk stratification tool still lacks. The patients’ disease assessment and operation method still rely on the doctors’ subjective anticipation of disease and surgical results.Case presentationA 31-year-old male presented with chest pain and hoarseness of recent onset. Imageological examination showed aortic rupture with mediastinal pseudoaneurysm in Zone 1. Debranching + TEVAR hybrid operation was considered: Using artificial blood vessels rebuild the arch branches, the covered stent was placed in aortic arch for endovascular repair via femoral artery. The follow-up was good in postoperative 7d, 1 year and > 2 years.ConclusionThe traumatic aortic arch rupture with pseudoaneurysm treated by Debranching+TEVAR hybrid operation is feasible. The short-term and medium-term follow-up results are satisfactory. For traumatic aortic arch injury, hybrid operation is recommended to reduce the risk of cardiopulmonary bypass and deep hypothermia circulatory arrest under no open operation conditions or emergency situation.

POSSIBILITIES OF APPLYING MATHEMATICAL ANALYSIS OF BLOOD FLOW CHARACTERISTICS IN ENDOVASCULAR TREATMENT OF AORTIC DISEASES USING HOLOMETALLIC STENTS

Purpose. The purpose of the article is to access possibilities of blood flow mathematical analysis in aortic aneurysm before and after bare metal stent implantation.Materials and methods. Mathematical models of aortic blood flow were based on data received at studying 15 CT-scans of patients with abdominal aorta aneurysms (12) and dissections (3) and their duplex ultra-sound hemodynamic data. At constructing mathematical model the program SolidWorks was used. Working with the program consisted of two stages: establishment of conditions for geometric objects; forming of abdominal aorta model from these objects. In the study hemodinamic aneurysm indexes was evaluated on rectilinear and curvilinear segments. Some of characteristics were variable: diameter, aneurysm wall thickness, its length, elasticity.Results. Correlation of extreme tension into aneurysm wall on rectilinear and curvilinear segments according to aneu­rysm wall thickness was assessed. Possibilities of pathological blood flow changes correction at bare metal stent im­plantation into aortic aneurysm were estimated: if presence of bare metal stent were introduced into mathematical parameters blood flow characteristics became almost as standard characteristics. Received data can enhance successful endovascular treatment of aortic diseases with using of bare metal stents.Conclusion. Mathematical models of aortic and vascular aneurysms before and after surgery can be an effective tool in bettering quality of medical help for vascular patients.

PACEMAKER FOLLOWING TRANSCATHETER AORTIC VALVE REPLACEMENT ASSOCIATED WITH INCREASED TRICUSPID REGURGITATION

Transcatheter Aortic Valve Replacement (TAVR) therapies have increased in the treatment of aortic disease. As TAVR procedures increase, more data is available on complications, such as the development of conduction abnormalities, often requiring pacemaker placement (PMP). A common complication of

Функциональная митральная недостаточность у пациентов при интервенционном лечении аортального порока

Функциональная митральная недостаточность у пациентов при интервенционном лечении аортального порока

Application value of diode laser in situ fenestration in the thoracic endovascular aortic repair for the treatment of aortic arch disease

Objective To evaluate the application value of diode laser in situ fenestration in the thoracic endovascular aortic repair (TEVAR) for the treatment of aortic arch disease. Methods The retrospective cross-sectional study was conducted. The clinical data of 110 patients with aortic arch disease who underwent TEVAR using diode laser in situ fenestration in the Ninth People′s Hospital of Shanghai Jiaotong University School of Medicine from January 2014 to June 2017 were collected. TEVAR using diode laser in situ fenestration was performed according to the lesion involving the three branches of aortic arch. Observation indicators: (1) surgical and intraoperative situations; (2) follow-up. All patients were followed up by outpatient examination, inpatient examination and telephone interview up to May 2017. CT angiography was performed to evaluate the patency of the stents and presence of endoleak at 3, 6, and 12 months postoperatively. Measurement data with normal distribution were represented as ±s. Results (1) Surgical and intraoperative situations: 106 of 110 patients underwent successful TEVAR using diode laser in situ fenestration. Intraoperative digital subtraction angiography (DSA) showed that primary aortic dissection incisions were completely closed, with a patency of all stents and no fenestration-related endoleaks. The surgical success rate was 96.36% (106/110). Two patients died of intraoperative pericardial tamponade and 2 received chimney stent implantation after complex anatomic configuration of the aortic arch inducing to failure of the innominate artery fenestration. Of 106 patients, 70 received left subclavian arterial fenestration, 30 received 3 aortic branches fenestration and 6 received both left subclavian arterial and left common carotid arterial fenestrations. The operation time and dose of contrast agent in 110 patients were respectively (140±9)minutes and (185±5)mL. Four patients had postoperative complications, 1 died of severe pulmonary infection and 3 with cerebral infarction were improved by anti-platelet, brain nerve nutrition and other symptomatic treatment. Other patients had no transient ischemic attack, stroke, brain infarction, myocardial infarction or other neurological complications. Duration of hospital stay of the 110 patients was (15 ± 7)days. (2) Follow-up: 99 of 107 patients were followed up for 2-17 months, with a median time of 10 months. During the follow-up, there were patencies of all stents, and endoleaks of 4 patients occurred and were closely followed up and observed. Conclusion The diode laser in situ fenestration is safe and feasible in the TEVAR for the treatment of aortic arch disease, with satisfactory short-term outcomes. Key words: Aortic dissection; Aortic aneurysm; Aortic arch; Thoracic endovascular aortic repair; In situ fenestration, diode laser

Failure modes and secondary endovascular interventions after endovascular aortic repair.

Endovascular repair has a firmly established role in the treatment of aortic disease. The development of endovascular devices to treat even complex aortic disease has broadened the panorama of repair significantly but has also introduced new forms of repair failure. Standard devices for EVAR and TEVAR have also been enhanced, providing better adaptation to the anatomy treated, smaller delivery systems, more intuitive delivery designs as well as improved features to facilitate precise delivery of the device. Improved imaging techniques also contribute to improved outcomes. The main subtypes of complications are still related to either endoleaks or stentgraft stenosis/occlusions. With more complex repairs also follow more complex failure modes. Choosing and planning a repair according to the specific patient anatomy without compromising the sealing zones of the repair remains vital to provide long-term durability. Continued surveillance is mandatory to improve not only repair durability but also to increase the knowledge of progressive aortic disease.

TCTAP A-035 Hybrid Operating Room Orientation for the Personalized Treatment of Aortic Diseases

TCTAP A-035 Hybrid Operating Room Orientation for the Personalized Treatment of Aortic Diseases

Thoracic aortic aneurysm

Aortic diseases contribute to the high overall cardiovascular mortality rate. The Global Burden Disease 2010 project demonstrated that the overall global death rate from aortic aneurysm and aortic dissection has increased in the past decade. Guidelines on the diagnosis and treatment of aortic diseases emphasize rapid and efficacious diagnostic strategies. In this paper, we review the imaging of a man with a thoracic aortic aneurysm diagnosed in an outpatient clinic. An 81-year-old man presented with recurring sweating, dizziness, and syncope. He had hypertension since he was 60 years old, which was well controlled. Two years previously, he had episodes of presyncope, fainting, sweating, and blood pressure fluctuations, ranging from 160e170/100 mmHg to 80/40 mmHg. No intracranial lesions were noted in brain computed tomography. Myocardial perfusion scintigraphy for myocardial ischemia was negative and an echocardiogram showed no abnormalities in the left ventricular ejection fraction or wall motion. Magnetic resonance imaging of the neck revealed a huge dilation of the aortic arch with a peripheral thrombus (Fig. 1, arrows). A series of plain chest radiographs revealed a high aortic arch (Fig. 2) with progressive elongation (Fig. 3). Altogether, the results indicated a diagnosis of a thoracic aortic aneurysm (TAA). The patient underwent a thoracic endovascular aortic repair. Postoperatively, he had an embolic stroke and pulmonary infection. He was discharged after 3 months of hospitalization and followed up in an outpatient clinic.

Comments on the 2014 ESC Guidelines on the Diagnosis and Treatment of Aortic Diseases

Comments on the 2014 ESC Guidelines on the Diagnosis and Treatment of Aortic Diseases

Successful 36 Months Result of Debranching TEVAR for Kommerell?s Diverticulm with the Aberrant Left Subclavian Artery

A case of successful endovascular repair of right aortic arch with the aberrant left subclavian artery (ALSA) arising from Kommerell’s diverticulum (KD). Our strategy consisted of coil embolization for the orifice of the ALSA, put the bypass between left common carotid artery and left subclavian artery and exclusion of KD by stent graft insertion. Enhanced computed tomography scan 36 months after the operation showed successful exclusion of KD, patency of the bypass graft, and no evidence of endoleak. Endovascular repair can be a safe and effective treatment for aortic disease with challenging anatomy in the midterm, avoiding the need for a complex open surgery procedure. It is very rare in this successful case with midterm result we presented.