-
Seminars in Vascular Surgery Mar 2022Pregnancy-associated aortic dissection (AD) is a rare event, with an incidence of 0.0004% per pregnancy. The work of the Aortic Dissection Collaborative identified... (Review)
Review
Pregnancy-associated aortic dissection (AD) is a rare event, with an incidence of 0.0004% per pregnancy. The work of the Aortic Dissection Collaborative identified pregnancy-associated AD as a high-priority topic, despite its rarity. The Pregnancy Working Group, which included physicians and patient stakeholders, performed a systematic literature review of pregnancy-associated AD from 1960 to 2021 and identified 6,333 articles through PubMed, OVID MEDLINE, Cochrane, Embase, CINAHL and Web of Science. The inclusion criterion was AD in pregnant populations and exclusion criteria were case reports, conference abstracts, and languages other than English. Assessment of full-text articles for eligibility after removal of duplicates from all databases yielded 68 articles to be included in the final review. Topics included were timing of AD in pregnancy, type of AD, and management considerations of pregnancy-associated AD. The Pregnancy Working Group identified gaps in knowledge and future areas of research for pregnancy-associated AD, including clinical management, mental health outcomes post AD, reproductive and genetic counseling, and contraception after AD. Future collaborative projects could be a multicenter, international registry for all pregnancy-associated AD to refine the risk factors, best practice and management of AD in pregnancy. In addition, future mixed methodology studies may be useful to explore social, mental, and emotional factors related to pregnancy-associated AD and to determine support groups' effect on anxiety and depression related to these events in the pregnancy and postpartum period.
Topics: Aortic Dissection; Female; Humans; Multicenter Studies as Topic; Postpartum Period; Pregnancy; Risk Factors
PubMed: 35501042
DOI: 10.1053/j.semvascsurg.2022.02.010 -
The Journal of Maternal-fetal &... Dec 2022Cervical artery dissection (CeAD) is responsible of one fifth of cases of ischemic stroke, but is uncommon during pregnancy or the early postpartum period and evidence...
BACKGROUND
Cervical artery dissection (CeAD) is responsible of one fifth of cases of ischemic stroke, but is uncommon during pregnancy or the early postpartum period and evidence is derived from published case reports and case series.
OBJECTIVES
This systematic review with a prospectively registered protocol was conducted to study the clinical presentation, management and prognosis of this condition.
METHODS
Ovid-Medline, PubMed Central, and CINAHL were searched without language restriction.
RESULTS
Fifty-seven articles (50 case reports and seven case series) reporting on 77 patients were included. The mean age was 33.7 years. The main possible risk factors identified were migraine, hyperlipidemia, connective tissue disorders, preeclampsia and eclampsia, HELLP syndrome and prolonged second stage of labor. Headache was the most frequent symptom, followed by neck pain. Acute medical treatments included anticoagulation, antiplatelets, and endovascular therapy. No patients received thrombolysis. The overall prognosis was good with 77.8% of patients making full clinical recovery.
CONCLUSIONS
Cervical artery dissection is a rare, but an important complication of pregnancy and puerperium. Diagnosis requires a high index of suspicion. The strong association with hypertensive and connective tissue disorders requires further research.
Topics: Adult; Female; Humans; Pregnancy; HELLP Syndrome; Postpartum Period; Pre-Eclampsia; Vertebral Artery Dissection; Pregnancy Complications, Cardiovascular; Risk Factors
PubMed: 36176066
DOI: 10.1080/14767058.2022.2122799 -
Frontiers in Cardiovascular Medicine 2015The acute event of thoracic aortic dissection carries with it high mortality and morbidity. Despite optimal initial surgical or medical management strategies, the risk... (Review)
Review
The acute event of thoracic aortic dissection carries with it high mortality and morbidity. Despite optimal initial surgical or medical management strategies, the risk of further complications in the long-term, including aneurysmal dilatation and false lumen (FL) expansion, are not insignificant. Adequate follow-up of such conditions requires dedicated imaging where relevant prognostic indicators are accurately assessed. We perform a systematic review of the literature and report the current evidence for the use of magnetic resonance imaging (MRI) in assessment of chronic aortic dissection. We then make a comparison with traditional imaging modalities including computed tomography and echocardiography. We discuss new ways in which MRI may extend existing aortic assessment, including identification of blood-flow dynamics within the TL and FL using phase-contrast imaging.
PubMed: 26664877
DOI: 10.3389/fcvm.2015.00005 -
Cancer Mar 2016There is uncertainty regarding the use of bladder-sparing alternatives to standard radical cystectomy, optimal lymph node dissection techniques, and optimal... (Review)
Review
There is uncertainty regarding the use of bladder-sparing alternatives to standard radical cystectomy, optimal lymph node dissection techniques, and optimal chemotherapeutic regimens. This study was conducted to systematically review the benefits and harms of bladder-sparing therapies, lymph node dissection, and systemic chemotherapy for patients with clinically localized muscle-invasive bladder cancer. Systematic literature searches of MEDLINE (from 1990 through October 2014), the Cochrane databases, reference lists, and the ClinicalTrials.gov Web site were performed. A total of 41 articles were selected for review. Bladder-sparing therapies were found to be associated with worse survival compared with radical cystectomy, although the studies had serious methodological shortcomings, findings were inconsistent, and only a few studies evaluated currently recommended techniques. More extensive lymph node dissection might be more effective than less extensive dissection at improving survival and decreasing local disease recurrence, but there were methodological shortcomings and some inconsistency. Six randomized trials found cisplatin-based combination neoadjuvant chemotherapy to be associated with a decreased mortality risk versus cystectomy alone. Four randomized trials found adjuvant chemotherapy to be associated with decreased mortality versus cystectomy alone, but none of these trials reported a statistically significant effect. There was insufficient evidence to determine optimal chemotherapeutic regimens.
Topics: Antineoplastic Combined Chemotherapy Protocols; Chemotherapy, Adjuvant; Cisplatin; Cystectomy; Evidence-Based Medicine; Humans; Lymph Node Excision; Neoadjuvant Therapy; Neoplasm Invasiveness; Organ Sparing Treatments; Randomized Controlled Trials as Topic; Survival Analysis; Treatment Outcome; Urinary Bladder Neoplasms
PubMed: 26773572
DOI: 10.1002/cncr.29843 -
Journal of Vascular Surgery Nov 2021The standard surgical approach to Stanford type A aortic dissection is open repair. However, up to one in four patients will be declined surgery because of prohibitive... (Meta-Analysis)
Meta-Analysis
OBJECTIVE
The standard surgical approach to Stanford type A aortic dissection is open repair. However, up to one in four patients will be declined surgery because of prohibitive risk. Patients who are treated nonoperatively have an unacceptably high mortality. Endovascular repair of the ascending aorta is emerging as an alternative treatment for a select group of patients. The reported rates of technical success, mortality, stroke, and reintervention have varied. The objective of the study was to systematically report outcomes for acute type A dissections repaired using an endovascular approach.
METHODS
The systematic review and meta-analysis was conducted in accordance with the PRISMA (preferred reporting items for systematic reviews and meta-analyses) guidelines. We performed online literature database searches through April 2020. The demographic and procedural characteristics of the individual studies were tabulated. Data on technical success, short-term mortality, stroke, and reintervention were extracted and underwent meta-analysis using a random effects model.
RESULTS
Fourteen studies with 80 cases of aortic dissection (55 acute and 25 subacute) were included in the final analysis. A wide variation was found in technique and device design across the studies. The outcomes rates were estimated at 17% (95% confidence interval [CI], 10%-26%) for mortality, 15% (95% CI, 8%-23%) for technical failure, 11% (95% CI, 6%-19%) for stroke and 18% (95% CI, 9%-31%) for reintervention. The mean Downs and Black quality assessment score was 13.9 ± 3.2.
CONCLUSIONS
The technique for endovascular repair of type A aortic dissection is feasible and reproducible. The results of our meta-analysis demonstrate an acceptable safety profile for inoperable patients who otherwise would have an extremely poor prognosis. Data from clinical trials are required before the technique can be introduced into routine clinical practice.
Topics: Adult; Aged; Aged, 80 and over; Aortic Dissection; Aortic Aneurysm; Blood Vessel Prosthesis Implantation; Clinical Decision-Making; Endovascular Procedures; Female; Humans; Male; Middle Aged; Patient Safety; Risk Assessment; Risk Factors; Treatment Outcome
PubMed: 33592292
DOI: 10.1016/j.jvs.2021.01.054 -
Journal of Cardiac Surgery Oct 2021Type B aortic dissection (TBAD), is defined as a dissection involving the aorta distal to left subclavian artery with the ascending aorta and the aortic arch not... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Type B aortic dissection (TBAD), is defined as a dissection involving the aorta distal to left subclavian artery with the ascending aorta and the aortic arch not affected. TBAD is classified due to the time frame and presence of complications. Complicated TBAD (co-TBAD) patients have a greater mortality rate than uncomplicated TBAD (un-TBAD) and thoracic endovascular aortic repair (TEVAR) is considered the gold-standard intervention for these clinical challenges.
METHODS
We undertook a systematic review of the literature regarding TEVAR intervention in co-TBAD and un-TBAD. A comprehensive search was undertaken across four major databases and was evaluated and assessed until June 2020.
RESULTS
A total of 16,104 patients were included in the study (7772 patients co-TBAD and 8352 un-TBAD). A significantly higher proportion of comorbidities were seen in co-TBAD patients compared with un-TBAD. Acute dissection was more frequent in the co-TBAD group (73.55% vs. 66.91%), while chronic dissection was more common in un-TBAD patients (33.8% vs. 70.73%). Postprocedure stroke was higher in co-TBAD (5.85% vs. 3.92%; p < .01), while postprocedural renal failure was higher in un-TBAD patients (7.23 vs. 11.38%; p < .01). No difference was observed in in-hospital mortality however the 30 days mortality was higher in the co-TBAD group. One-year survival was higher in the uncomplicated group but this difference was not observed in the 5-year survival.
CONCLUSION
In our analysis we can appreciate that despite significantly higher comorbidities in the co-TBAD cohort, there was no difference in in-hospital mortality between the two groups and the 5-year survival did not have any difference.
Topics: Aortic Dissection; Aorta, Thoracic; Aortic Aneurysm, Thoracic; Blood Vessel Prosthesis Implantation; Endovascular Procedures; Humans; Retrospective Studies; Risk Factors; Time Factors; Treatment Outcome
PubMed: 34310731
DOI: 10.1111/jocs.15827 -
Annals of Vascular Surgery Sep 2022To provide a contemporary review on endovascular false lumen (FL) embolization for thoracic aortic dissection (AD) and evaluate its early outcome. (Review)
Review
BACKGROUND
To provide a contemporary review on endovascular false lumen (FL) embolization for thoracic aortic dissection (AD) and evaluate its early outcome.
METHODS
A systematic literature review on FL embolization for thoracic AD from January 2003 to December 2020 was performed under the instruction of Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Each article was analyzed using a standardized protocol including predefined demographic characteristics, perioperative mortality, and major complications.
RESULTS
A total of 29 papers with 229 patients were included into the analysis. The methods of FL occlusion used were the candy-plug technique, the knickerbocker technique, the "cork in the bottleneck" technique, and direct FL embolization with a combination of stent-grafts, coils, onyx, plugs, and glue. FL embolization procedure was performed in 79 patients (34.5%) with type A AD and 150 (65.5%) with type B AD. FL direct embolization was the most frequently used technique and it was applied in 198 (86.5%) patients. Candy-plug, knickerbocker, and "cork in the bottleneck" techniques were used in 26 (11.4%), 3 (1.3%), and 2 (0.9%) patients, respectively. Technical success was achieved in all patients except one (228/229, 99.6%) in which implantation of a stent to celiac trunk was not possible. There were 4 hospital deaths (1.7%). Neurological complications occurred in 6 patients (2.6%), including 4 (1.7%) spinal cord ischemia and 2 (0.9%) ischemic stroke. There were 1 (0.4%) iatrogenic retrograde dissection and 2 (0.9%) renal failure reported. The mean duration of follow-up was 16.5 months. There were 21 deaths (9.3%) during follow-up and 8 (3.6%) were aorta-related. Thirty three (14.7%) secondary interventions were performed. Five patients (2.2%) required an open completion thoracoabdominal procedure incorporating the stent-graft into the repair. Complete FL thrombosis was observed in 181 (80.4%) patients, 34 (15.1%) had partial thrombosis, and 10 (4.4%) had FL progression.
CONCLUSIONS
FL embolization of the distal thoracic aorta is a promising technique in a group of patients to promote FL thrombosis and aortic remodeling in thoracic aorta.
Topics: Aortic Dissection; Aortic Aneurysm, Thoracic; Blood Vessel Prosthesis; Blood Vessel Prosthesis Implantation; Endovascular Procedures; Humans; Retrospective Studies; Stents; Thrombosis; Time Factors; Treatment Outcome
PubMed: 35339592
DOI: 10.1016/j.avsg.2022.03.020 -
Journal of Vascular Surgery Oct 2018Spontaneous isolated celiac artery dissection (SICAD) and spontaneous isolated superior mesenteric artery dissection (SISMAD) represent the major types of spontaneous... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
Spontaneous isolated celiac artery dissection (SICAD) and spontaneous isolated superior mesenteric artery dissection (SISMAD) represent the major types of spontaneous visceral artery dissection. However, no quantitative meta-analysis of SICAD and SISMAD is available. The aim of our study was to pool current evidence concerning basic profiles, treatment strategies, long-term adverse events, and morphologic changes of lesioned vessels in SICAD and SISMAD patients.
METHODS
We searched the MEDLINE, Embase, Scopus, and Cochrane Databases (January 1, 1946-September 21, 2017) for studies of SICAD and SISMAD. Related cohort studies or case series with sample size larger than 10 were included. Two reviewers independently extracted and summarized the data. A random-effects model was used to calculate pooled estimates.
RESULTS
In total, 43 studies were included. An estimated 8% (95% confidence interval [CI], 0.01-0.21) symptomatic SICAD and 12% (95% CI, 0.06-0.19) symptomatic SISMAD patients with initial conservative management required secondary intervention during follow-up, whereas none of the asymptomatic patients treated conservatively required secondary intervention. As for morphologic changes during follow-up, a higher proportion of SICAD patients (64%; 95% CI, 0.47-0.80) achieved complete remodeling compared with SISMAD patients (25%; 95% CI, 0.19-0.32), and an estimated 6% (95% CI, 0.00-0.16) of SICAD and 12% (95% CI, 0.05-0.20) of SISMAD patients had morphologic progression. Overall, the pooled estimate of long-term all-cause mortality was 0% (95% CI, 0.00-0.03) in SICAD and 1% (95% CI, 0.00-0.02) in SISMAD. When stratified by symptoms, symptomatic patients were associated with a significantly increased probability of accomplishing complete remodeling (odds ratio, 3.95; 95% CI, 1.31-11.85) compared with asymptomatic patients.
CONCLUSIONS
Initial conservative treatment is safe for asymptomatic SICAD or SISMAD patients. Symptomatic patients managed conservatively have relatively high occurrence of late secondary intervention, which may require closer surveillance, especially in SISMAD because of a lower rate of remodeling.
Topics: Adult; Aged; Aged, 80 and over; Aortic Dissection; Anticoagulants; Asymptomatic Diseases; Celiac Artery; Clinical Decision-Making; Conservative Treatment; Endovascular Procedures; Female; Fibrinolytic Agents; Humans; Male; Mesenteric Artery, Superior; Middle Aged; Odds Ratio; Platelet Aggregation Inhibitors; Risk Factors; Time Factors; Treatment Outcome; Vascular Remodeling; Vascular Surgical Procedures
PubMed: 30126785
DOI: 10.1016/j.jvs.2018.05.014 -
International Journal of Surgery... Jan 2016Recently, several authors introduced various methods and published feasibility studies on novel robotic-assisted neck dissection techniques for head and neck cancer... (Review)
Review
INTRODUCTION
Recently, several authors introduced various methods and published feasibility studies on novel robotic-assisted neck dissection techniques for head and neck cancer patients. Cosmesis and general appearance have become important concerns of cancer patients today. Especially in the head and neck area, a conspicuous scar can reduce patient satisfaction after surgery. With conventional neck dissection techniques, a long scar in the neck is unavoidable. Therefore, the development of robotic assisted neck dissection provides the patients with a scarless neck in these situations. However, there are some limitations of the application of these techniques in their current stage of development.
METHODS
This study was performed using a systematic literature review.
RESULTS
The reviewed clinical studies show that robotic-assisted neck dissection yields similar functional and early oncologic outcomes to that of conventional neck dissection, as well as excellent cosmetic satisfaction of patients. Despite these benefits, some disadvantages can be observed, in terms of longer operation times as well as higher procedure costs.
CONCLUSION
Besides the similar oncologic and functional outcomes compared with the open procedure so far, more prospective, controlled, multicenter studies are required to establish robotic-assisted neck dissection as an alternative standard and to justify its added costs beyond the cosmetic advantages.
Topics: Esthetics; Head and Neck Neoplasms; Humans; Neck Dissection; Operative Time; Patient Satisfaction; Prospective Studies; Robotic Surgical Procedures; Thyroid Neoplasms; Thyroidectomy
PubMed: 26602968
DOI: 10.1016/j.ijsu.2015.11.022 -
Annals of Vascular Surgery Jul 2016The purpose of this study is to perform a systematic literature review of isolated spontaneous celiac trunk dissection (ISCTD), to evaluate initial clinical and... (Review)
Review
BACKGROUND
The purpose of this study is to perform a systematic literature review of isolated spontaneous celiac trunk dissection (ISCTD), to evaluate initial clinical and diagnostic aspects, treatment modalities, and outcomes.
METHODS
A retrospective search of MEDLINE, Cochrane, and SciELO databases was performed, using the terms celiac artery dissection, celiac trunk dissection, hepatic artery dissection, splenic artery dissection, or left gastric artery dissection to identify instances of ISCTD. Patients with associated aortic and/or other visceral artery dissection were excluded. When available, the following information was collected from each case: gender, age, associated risk factor, symptoms, diagnostic method, treatment modality, and outcome.
RESULTS
A total of 60 publications were identified between 1987 and 2015, with 11 cases series and 49 case reports, achieving a total of 169 patients identified with ISCTD. Such information was collected: 99 patients were male and 17 female, with an average age of 53.1 years and the most common symptom was abdominal pain. Diagnosis was mainly made with computed tomography. The most common associated conditions were hypertension and smoking in 31% and 23% of the cases, respectively. Conservative treatment was performed in 79% of the cases.
CONCLUSIONS
The profile of patients with ISCTD is male, middle aged, and almost all suffer from abdominal pain. Initial conservative treatment seems adequate for most cases, but a few patients will require interventional treatment. Clinical and radiological long-term follow-up is mandatory, owing to the risk of later progression to aneurysm.
Topics: Abdominal Pain; Adult; Aortic Dissection; Celiac Artery; Computed Tomography Angiography; Female; Humans; Male; Middle Aged; Predictive Value of Tests; Risk Factors; Treatment Outcome
PubMed: 27126716
DOI: 10.1016/j.avsg.2015.12.009