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Deutsche Medizinische Wochenschrift... Jan 2015Acute aortic syndrome (AAS) is a rather rare but often life-threatening cause of thoraco-abdominal pain. AAS includes acute aortic dissection (AD), intramural hematoma...
Acute aortic syndrome (AAS) is a rather rare but often life-threatening cause of thoraco-abdominal pain. AAS includes acute aortic dissection (AD), intramural hematoma (IMH) and penetrating atherosclerotic ulcer (PAU), in which the latter may progress to AD. Suddenly emerging severe pain localized in the chest, back or the abdomen is rather characteristic for acute AD, but painless courses of the disease are also possible. Rapid diagnosis and treatment are crucial for prognosis and survival. Aortic contrast-enhanced computed tomography is the method of choice due to its broad availability, distinguished accuracy and rapid feasibility. In instable patients, transoesophagel echocardiography by an experienced examiner is also applicable. Patients suffering from Type A AD need urgent surgery in most cases, patients.
Topics: Aortic Aneurysm; Aortic Valve Stenosis; Chest Pain; Diagnosis, Differential; Humans; Syndrome; Thrombosis
PubMed: 25612282
DOI: 10.1055/s-0040-100585 -
Seminars in Vascular Surgery Jun 2023For a long time, parallel grafting, physician-modified endografts, and, more recently, in situ fenestration were the only go-to endovascular options for ruptured... (Review)
Review
For a long time, parallel grafting, physician-modified endografts, and, more recently, in situ fenestration were the only go-to endovascular options for ruptured thoracoabdominal aortic aneurysm, offered mixed results, and depended mainly on the operator's and center's experience. As custom-made devices have become an established endovascular treatment option for elective thoracoabdominal aortic aneurysm, they are not a viable option in the emergency setting, as endograft production can take up to 4 months. The development of off-the-shelf (OTS) multibranched devices with a standardized configuration has allowed the treatment of ruptured thoracoabdominal aortic aneurysm with emergent branched endovascular procedures. The Zenith t-Branch device (Cook Medical) was the first readily available graft outside the United States to receive the CE mark (in 2012) and is currently the most studied device for those indications. A new device, the E-nside thoracoabdominal branch endoprosthesis OTS multibranched endograft (Artivion), has been made commercially available, and the GORE EXCLUDER thoracoabdominal branch endoprosthesis OTS multibranched endograft (W. L. Gore and Associates) is expected to be released in 2023. Due to the lack of guidelines on ruptured thoracoabdominal aortic aneurysm, this review summarizes the available treatment options (ie, parallel grafts, physician-modified endografts, in situ fenestrations, and OTS multibranched devices), compares the indications and contraindications, and points out the evidence gaps that should be filled in the next decade.
Topics: Humans; Blood Vessel Prosthesis; Blood Vessel Prosthesis Implantation; Aortic Aneurysm, Thoracoabdominal; Aortic Aneurysm, Thoracic; Treatment Outcome; Prosthesis Design; Stents; Endovascular Procedures; Aortic Rupture; Aortic Aneurysm, Abdominal
PubMed: 37330232
DOI: 10.1053/j.semvascsurg.2023.04.004 -
Seminars in Vascular Surgery Mar 2016Management of aortic aneurysm disease has changed in the endovascular era, with the majority of patients opting for stent-graft repair of abdominal and thoracic... (Review)
Review
Management of aortic aneurysm disease has changed in the endovascular era, with the majority of patients opting for stent-graft repair of abdominal and thoracic aneurysms. An understanding of this vascular condition is important for primary care, emergency medicine, medicine specialists, and vascular surgeons alike. Awareness of the patient risk factors for aneurysmal degeneration, sac rupture, and medical management allows physicians to screen appropriate patient populations, which decreases aneurysm-related mortality due to rupture. The evolving endovascular techniques available today have made more patients eligible for this less-invasive repair, which has lower mortality and morbidity compared with open surgery with aorta replacement. This review provides contemporary information on the etiology, natural history, evaluation, and management of aortic aneurysm disease. The complications of prior aortic repair, whether performed via endovascular or open surgery intervention, are equally important to understanding not only for vascular surgeons performing these procedures, but also for primary care, emergency department, and medicine specialists who are evaluating these patients in an office or hospital setting.
Topics: Aortic Aneurysm, Abdominal; Aortic Aneurysm, Thoracic; Blood Vessel Prosthesis; Blood Vessel Prosthesis Implantation; Endovascular Procedures; Humans; Randomized Controlled Trials as Topic; Risk Factors; Stents
PubMed: 27823587
DOI: 10.1053/j.semvascsurg.2016.07.003 -
The Journal of Thoracic and... Jun 2022
Topics: Aorta; Aortic Aneurysm; Humans
PubMed: 33744012
DOI: 10.1016/j.jtcvs.2021.02.046 -
European Journal of Vascular and... Nov 2022
Topics: Humans; Netherlands; Aortic Aneurysm, Abdominal; Endovascular Procedures; Aortic Aneurysm; Treatment Outcome; Blood Vessel Prosthesis Implantation
PubMed: 36270498
DOI: 10.1016/j.ejvs.2022.10.023 -
General Thoracic and Cardiovascular... Jan 2019Reoperative thoracoabdominal aortic aneurysm repair is frequently necessary and brings with it a unique set of challenges. Typically, most reoperative repairs are... (Review)
Review
Reoperative thoracoabdominal aortic aneurysm repair is frequently necessary and brings with it a unique set of challenges. Typically, most reoperative repairs are necessitated by aortic disease progressing into previously healthy aortic tissue from a replaced section of the aorta (an extension of the previous repair) or, to a lesser degree, because of a late complication of prior distal aortic repair (an open or endovascular repair failure). Characterizing the reason for the reoperation as well as the location of prior repair is the first step towards anticipating major outcomes following such repair. Since the introduction of endovascular repair for aortic aneurysms, indications for open repair have become more specific and limited; many centers have justified using endovascular approaches in patients with prior open aortic repair by deeming these patients "high risk" because of their previous incision. Our analysis found that reoperative repairs were not typically subject to worse early outcomes than patients without prior distal aortic repair, except for the more complicated types of reoperation, which involve infection.
Topics: Aortic Aneurysm; Aortic Aneurysm, Thoracic; Blood Vessel Prosthesis Implantation; Cardiac Surgical Procedures; Humans; Plastic Surgery Procedures; Reoperation; Treatment Outcome
PubMed: 30069676
DOI: 10.1007/s11748-018-0978-y -
Journal of Vascular Surgery Aug 2023Endovascular aortic aneurysm repair (EVAR) has lower rates of postoperative mortality and morbidity when compared with open repair. However, endovascular repair still...
OBJECTIVE
Endovascular aortic aneurysm repair (EVAR) has lower rates of postoperative mortality and morbidity when compared with open repair. However, endovascular repair still carries the risk of postoperative dialysis, paralysis, and stroke. This study examined the rates of postoperative mortality and morbidity stratified by type of endovascular aortic aneurysm repair.
METHODS
All patients who underwent EVAR in the Vascular Quality Initiative registry from January 2011 to May 2022 were identified. Patients were stratified by repair type: infrarenal EVAR, complex EVAR, thoracic endovascular aortic repair (TEVAR), extent I to III thoracoabdominal aortic aneurysm (TAAA) repair, or aortic arch repair. The primary outcome was postoperative thoracoabdominal aortic aneurysm life-altering events (TALE) across the different treatment groups. TALE was defined as a composite outcome of postoperative mortality, dialysis, paralysis, and/or stroke. Mixed effect logistic regression modeling was used to identify procedural and anatomic factors that were independently associated with TALE.
RESULTS
A total of 52,592 EVARs, 3768 complex EVARs, 3899 TEVARs, 1139 extent I to III TAAA repairs, and 479 arch repairs were identified. TALE was observed in 1.2% of EVARs, 4.8% of complex EVARs, 6.0% of TEVARs, 10% of extent I to III TAAA repairs, and 14% of arch repairs. More proximal landing zone was associated with higher odds of TALE after complex EVAR (odds ratio [OR], 1.9; 95% confidence interval [CI], 1.2-3.1; P = .008), TEVAR (OR, 2.2; 95% CI, 1.4-3.5; P = .001), and extent I to III TAAA repair (OR, 2.7; 95% CI, 1.5-4.9; P = .001). Aortic diameter >65 mm was associated with higher odds of TALE after infrarenal EVAR (OR, 1.8; 95% CI, 1.4-2.3; P < .001), complex EVAR (OR, 1.6; 95% CI, 1.1-2.3; P = .010), TEVAR (OR, 2.7; 95% CI, 2.0-3.8; P < .001), and arch repair (OR, 2.4; 95% CI, 1.3-4.4; P = .007). The use of parallel grafting technique (chimney/snorkel/periscope) during extent I to III TAAA repair was also associated with higher odds of TALE (OR, 1.8; 95% CI, 1.1-3.2; P = .032). Preoperative chronic kidney disease was also associated with higher odds of TALE after infrarenal EVAR (OR, 4.3; 95% CI, 3.0-5.7; P < .001), complex EVAR (OR, 5.2; 95% CI, 3.3-8.2; P < .001), TEVAR (OR, 4.5; 95% CI, 2.8-7.1; P < .001), and extent I to III TAAA repair (OR, 3.2; 95% CI, 1.6-6.7; P = .001).
CONCLUSIONS
Although TALE was originally described for TAAA repairs, TALE may occur after complex EVAR, TEVAR, and arch repairs as well. Therefore, TALE and its component parts should be used to evaluate the efficacy of all aortic repairs and for preoperative counseling. Additionally, surgeons should be aware of anatomic and procedural characteristics that are associated with higher odds of TALE. The anticipated need for such interventions during aortic repair should be factored into preoperative risk assessment of patients.
Topics: Humans; Endovascular Aneurysm Repair; Aortic Aneurysm, Thoracoabdominal; Blood Vessel Prosthesis Implantation; Endovascular Procedures; Risk Factors; Postoperative Complications; Stroke; Treatment Outcome; Retrospective Studies; Aortic Aneurysm, Thoracic; Aortic Aneurysm, Abdominal
PubMed: 37044316
DOI: 10.1016/j.jvs.2023.03.499 -
Seminars in Vascular Surgery Dec 2023Thoracic and thoracoabdominal aortic aneurysms are more common in men. Yet, females often have worse outcomes, fewer interventions, and lower treatment rates. Females... (Review)
Review
Thoracic and thoracoabdominal aortic aneurysms are more common in men. Yet, females often have worse outcomes, fewer interventions, and lower treatment rates. Females have also benefited less from the research and treatment of those diseases than men. Understanding sex- and sex-specific differences in thoracic and thoracoabdominal aortic aneurysms can improve care delivery, reduce disparities, and optimize outcomes for females with thoracic aortic aneurysms and thoracoabdominal aortic aneurysms. The authors reviewed the literature on the presentation and outcomes of thoracic and thoracoabdominal aortic aneurysms in females, discussing the existing gaps and future directions to address them.
Topics: Male; Humans; Female; Aortic Aneurysm, Thoracoabdominal; Aortic Aneurysm, Thoracic; Vascular Surgical Procedures; Time Factors; Retrospective Studies; Treatment Outcome; Aortic Aneurysm, Abdominal; Postoperative Complications
PubMed: 38030324
DOI: 10.1053/j.semvascsurg.2023.10.004 -
Arteriosclerosis, Thrombosis, and... Nov 2022
Topics: Humans; Aortic Aneurysm, Thoracic; Aortic Aneurysm; Genomics; Stents; Blood Vessel Prosthesis Implantation
PubMed: 36200445
DOI: 10.1161/ATVBAHA.122.318525 -
The Journal of Cardiovascular Surgery Oct 2022Patients with complex aortic aneurysms (CAA) are often high risk due to advanced age and widespread atherosclerosis affecting numerous vascular territories. Therefore, a... (Review)
Review
Patients with complex aortic aneurysms (CAA) are often high risk due to advanced age and widespread atherosclerosis affecting numerous vascular territories. Therefore, a thorough perioperative evaluation is needed prior to performing in any type of aortic repair, regardless of whether an endovascular or open surgical approach is selected. Because these operations are technically demanding and often result in end organ ischemia, it is not surprising that complex aortic repair carries significant risk of morbidity and mortality. Disabling complications such as dialysis, major stroke and paraplegia constitute the main limitation of complex aortic repair. The aim of this article was to review postoperative management to mitigate complications after CAA repair.
Topics: Aortic Aneurysm; Aortic Aneurysm, Abdominal; Aortic Aneurysm, Thoracic; Blood Vessel Prosthesis Implantation; Endovascular Procedures; Humans; Postoperative Complications; Retrospective Studies; Risk Factors; Treatment Outcome
PubMed: 35687066
DOI: 10.23736/S0021-9509.22.12359-1