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Annals of Vascular Surgery Aug 2021Despite the great evolution of endograft devices for thoracic endovascular aortic repair (TEVAR), threatening related complication such as graft migration and endoleaks... (Review)
Review
BACKGROUND
Despite the great evolution of endograft devices for thoracic endovascular aortic repair (TEVAR), threatening related complication such as graft migration and endoleaks still occur during follow up. The Drag Forces (DF), that is the displacement forces that play a role in graft migration and endoleaks caused by the blood flow against the thoracic graft, can be studied by means of Computational Fluid Dynamics (CFD).
METHOD
A general review of papers found in current literature was performed. CFD studies available on the topic of thoracic aortic diseases and DF were analyzed. All anatomic, hemodynamics or graft related factors which could have an impact on DF were reported.
RESULTS
Different factors deeply influence DF magnitude in the different site of the Ishimaru's zones classification: angulation, tortuosity and length of the landing zone, graft diameter, length and deployment position, blood pressure, pulse waveform, blood viscosity and patient heart rate have been related to the magnitude of DF. Moreover, also the three-dimensional orientation of DF is emerging as a fundamental issue from CFD studies. DF can be divided in sideways and upward components. The former, even of higher magnitude in zone 0, maintain always an orthogonal orientation and does not change in any type of aortic arch; the latter result strictly related to the anatomic complexity of the aortic arch with values up to four times higher in zone 3.
CONCLUSION
Different DF magnitude and orientation could explain how TEVAR have higher rate of migration and endoleaks when we face with more complex aortic anatomies. All these aspects should be foreseen during the planning of TEVAR procedure. In this field, collaboration between physicians and engineers is crucial, as both parts have a primary role in understanding and describing hidden aspects involved in TEVAR procedures.
Topics: Aorta, Thoracic; Aortic Diseases; Blood Vessel Prosthesis; Blood Vessel Prosthesis Implantation; Endoleak; Endovascular Procedures; Foreign-Body Migration; Humans; Hydrodynamics; Models, Cardiovascular; Patient-Specific Modeling; Regional Blood Flow; Risk Assessment; Risk Factors; Stress, Mechanical; Treatment Outcome
PubMed: 33823255
DOI: 10.1016/j.avsg.2021.02.042 -
The Journal of Thoracic and... Jun 2020
Topics: Aorta, Thoracic; Aortic Aneurysm, Thoracic; Blood Vessel Prosthesis Implantation; Heart Defects, Congenital; Humans
PubMed: 31014664
DOI: 10.1016/j.jtcvs.2019.03.086 -
Journal of Nuclear Cardiology :... Jun 2022Standard methods for quantifying positron emission tomography (PET) uptake in the aorta are time consuming and may not reflect overall vessel activity. We describe...
BACKGROUND
Standard methods for quantifying positron emission tomography (PET) uptake in the aorta are time consuming and may not reflect overall vessel activity. We describe aortic microcalcification activity (AMA), a novel method for quantifying F-sodium fluoride (18F-NaF) uptake in the thoracic aorta.
METHODS
Twenty patients underwent two hybrid F-NaF PET and computed tomography (CT) scans of the thoracic aorta less than three weeks apart. AMA, as well as maximum (TBRmax) and mean (TBRmean) tissue to background ratios, were calculated by two trained operators. Intra-observer repeatability, inter-observer repeatability and scan-rescan reproducibility were assessed. Each F-NaF quantification method was compared to validated cardiovascular risk scores.
RESULTS
Aortic microcalcification activity demonstrated excellent intra-observer (intraclass correlation coefficient 0.98) and inter-observer (intraclass correlation coefficient 0.97) repeatability with very good scan-rescan reproducibility (intraclass correlation coefficient 0.86) which were similar to previously described TBRmean and TBRmax methods. AMA analysis was much quicker to perform than standard TBR assessment (3.4min versus 15.1min, P<0.0001). AMA was correlated with Framingham stroke risk scores and Framingham risk score for hard cononary heart disease.
CONCLUSIONS
AMA is a simple, rapid and reproducible method of quantifying global F-NaF uptake across the ascending aorta and aortic arch that correlates with cardiovascular risk scores.
Topics: Aorta, Thoracic; Calcinosis; Fluorine Radioisotopes; Humans; Positron Emission Tomography Computed Tomography; Reproducibility of Results; Sodium Fluoride
PubMed: 33474695
DOI: 10.1007/s12350-020-02458-w -
Scandinavian Journal of Trauma,... Dec 2023Selective aortic arch perfusion (SAAP) is a novel endovascular technique that combines thoracic aortic occlusion with extracorporeal perfusion of the brain and heart....
BACKGROUND
Selective aortic arch perfusion (SAAP) is a novel endovascular technique that combines thoracic aortic occlusion with extracorporeal perfusion of the brain and heart. SAAP may have a role in both haemorrhagic shock and in cardiac arrest due to coronary ischaemia. Despite promising animal studies, no data is available that describes SAAP in humans. The primary aim of this study was to assess the feasibility of selective aortic arch perfusion in humans. The secondary aim of the study was to assess the feasibility of achieving direct coronary artery access via the SAAP catheter as a potential conduit for salvage percutaneous coronary intervention.
METHODS
Using perfused human cadavers, a prototype SAAP catheter was inserted into the descending aorta under fluoroscopic guidance via a standard femoral percutaneous access device. The catheter balloon was inflated and the aortic arch perfused with radio-opaque contrast. The coronary arteries were cannulated through the SAAP catheter.
RESULTS
The procedure was conducted four times. During the first two trials the SAAP catheter was passed rapidly and without incident to the intended descending aortic landing zone and aortic arch perfusion was successfully delivered via the device. The SAAP catheter balloon failed on the third trial. On the fourth trial the left coronary system was cannulated using a 5Fr coronary guiding catheter through the central SAAP catheter lumen.
CONCLUSIONS
For the first time using a perfused cadaveric model we have demonstrated that a SAAP catheter can be easily and safely inserted and SAAP can be achieved using conventional endovascular techniques. The SAAP catheter allowed successful access to the proximal aorta and permitted retrograde perfusion of the coronary and cerebral circulation.
Topics: Humans; Aorta; Aorta, Thoracic; Heart Arrest; Perfusion; Shock, Hemorrhagic; Feasibility Studies
PubMed: 38087352
DOI: 10.1186/s13049-023-01148-z -
Annals of Vascular Surgery Sep 2023Aberrant subclavian artery (ASA) with or without Kommerell's diverticulum (KD) is a rare anatomic aortic arch anomaly that can cause dysphagia and/or life-threatening...
BACKGROUND
Aberrant subclavian artery (ASA) with or without Kommerell's diverticulum (KD) is a rare anatomic aortic arch anomaly that can cause dysphagia and/or life-threatening rupture. The objective of this study is to compare outcomes of ASA/KD repair in patients with a left versus right aortic arch.
METHODS
Using the Vascular Low Frequency Disease Consortium methodology, a retrospective review was performed of patients ≥18 years old with surgical treatment of ASA/KD from 2000 to 2020 at 20 institutions.
RESULTS
288 patients with ASA with or without KD were identified; 222 left-sided aortic arch (LAA), and 66 right-sided aortic arch (RAA). Mean age at repair was younger in LAA 54 vs. 58 years (P = 0.06). Patients in RAA were more likely to undergo repair due to symptoms (72.7% vs. 55.9%, P = 0.01), and more likely to present with dysphagia (57.6% vs. 39.1%, P < 0.01). The hybrid open/endovascular approach was the most common repair type in both groups. Rates of intraoperative complications, death within 30 days, return to the operating room, symptom relief and endoleaks were not significantly different. For patients with symptom status follow-up data, in LAA, 61.7% had complete relief, 34.0% had partial relief and 4.3% had no change. In RAA, 60.7% had complete relief, 34.4% had partial relief and 4.9% had no change.
CONCLUSIONS
In patients with ASA/KD, RAA patients were less common than LAA, presented more frequently with dysphagia, had symptoms as an indication for intervention, and underwent treatment at a younger age. Open, endovascular and hybrid repair approaches appear equally effective, regardless of arch laterality.
Topics: Adolescent; Humans; Aorta, Thoracic; Deglutition Disorders; Diverticulum; Heart Defects, Congenital; Subclavian Artery; Treatment Outcome; Vascular Diseases; Adult; Middle Aged
PubMed: 37236537
DOI: 10.1016/j.avsg.2023.05.005 -
Interactive Cardiovascular and Thoracic... May 2022Our aim was to describe the outcomes of the latest treatment options of acute non-A non-B aortic dissection involving an entry tear in the aortic arch.
OBJECTIVES
Our aim was to describe the outcomes of the latest treatment options of acute non-A non-B aortic dissection involving an entry tear in the aortic arch.
METHODS
Included were patients who presented between January 2001 and February 2020 with a non-A non-B aortic dissection involving the aortic arch but not the ascending aorta and with the most proximal entry tear located within the aortic arch between the innominate and left subclavian artery. Clinical data and operative details were retrieved from medical histories and surgical protocols. Preoperative, postoperative and follow-up computed tomography angiography scans were analysed.
RESULTS
We analysed a total of 39 patients [median age 62 (52; 67) years, men 76.9%] with non-A non-B arch entry aortic dissections type. They underwent 15 thoracic endovascular aortic repairs, 20 frozen elephant trunk implantations, 1 hybrid arch replacement, or 1 conventional arch replacement. Two patients were managed conservatively. Twelve (31%) patients underwent emergent intervention, 12 (31%) were treated invasively within 2 weeks. Another 2 (5%) and 9 (23%) patients were treated 2 and 4 weeks after dissection occurred, respectively. Six (15%) patients presented with an impending aortic rupture, while 19 (49%) had at least one malperfused organ. Four patients (27%) died after thoracic endovascular aortic repair; the 30-day mortality following frozen elephant trunk was 0%.
CONCLUSIONS
Non-A non-B acute aortic dissection reveals a frequently complicated course requiring emergency intervention. The majority of patients required aortic arch repair within the first 2 weeks. Total arch replacement with the frozen elephant trunk technique seems to be low procedural mortality, and may become the treatment of choice in arch entry non-A non-B aortic dissection.
Topics: Aortic Dissection; Aorta, Thoracic; Aortic Aneurysm, Thoracic; Blood Vessel Prosthesis Implantation; Humans; Male; Middle Aged; Retrospective Studies; Stents; Subclavian Artery; Treatment Outcome
PubMed: 35137081
DOI: 10.1093/icvts/ivab375 -
The American Journal of Cardiology Jun 2022Previous studies have shown that bovine arch incidence is higher in patients with thoracic aortic aneurysms than in patients without an aneurysm. Although thoracic...
Previous studies have shown that bovine arch incidence is higher in patients with thoracic aortic aneurysms than in patients without an aneurysm. Although thoracic aortic aneurysm disease is known to be familial in some cases, it remains unknown if bovine arch results from a genetic mutation, thus allowing it to be inherited. Our objective was to determine the heritability of bovine arch from phenotypic pedigrees. We identified 24 probands from an institutional database of 202 living patients with bovine arch who had previously been diagnosed with thoracic aortic aneurysm and who had family members with previous chest computed tomography or magnetic resonance imaging scans. Aortic arch configuration of all first-degree and second-degree relatives was determined from available scans. Heritability of bovine arch was estimated using maximum-likelihood-based variance decomposition methodology implemented by way of the SOLAR package (University of Maryland, Catonsville, Maryland). 43 relatives of 24 probands with bovine arch had preexisting imaging available for review. The prevalence of bovine arch in relatives with chest imaging was 53% (n = 23) and did not differ significantly by gender (male: 64.3%, female: 55.6%, p = 1). The bovine arch was shown to be highly heritable with a heritability estimate (h) of 0.71 (p = 0.048). In conclusion, the high heritability of bovine arch in our sample population suggests a genetic basis.
Topics: Aneurysm; Aorta, Thoracic; Aortic Aneurysm, Thoracic; Female; Humans; Incidence; Likelihood Functions; Male; Retrospective Studies
PubMed: 35321803
DOI: 10.1016/j.amjcard.2022.02.030 -
European Journal of Cardio-thoracic... Oct 2020
Topics: Aorta, Thoracic; Aortic Diseases; Betacoronavirus; COVID-19; Coronavirus Infections; Humans; Male; Middle Aged; Pandemics; Pneumonia, Viral; SARS-CoV-2; Thrombosis; Tomography, X-Ray Computed
PubMed: 32820319
DOI: 10.1093/ejcts/ezaa304 -
The Journal of Thoracic and... Feb 2020
Topics: Aorta, Thoracic; Aortic Diseases; Arterial Switch Operation; Cardiovascular Abnormalities; Humans; Transposition of Great Vessels
PubMed: 31669010
DOI: 10.1016/j.jtcvs.2019.08.110 -
Journal of Cardiothoracic Surgery Sep 2019Double aortic arch (DAA) is a rare congenital vascular malformation. This study aims to summarize the experience of diagnosis and surgical treatment for congenital...
OBJECTIVES
Double aortic arch (DAA) is a rare congenital vascular malformation. This study aims to summarize the experience of diagnosis and surgical treatment for congenital double aortic arch.
METHODS
The clinical data of 24 cases with double aortic arch (DAA) from January 2008 to January 2018 in our hospital was reviewed retrospectively.
RESULTS
A total of 24 cases, including 12 patients with isolated DAA and 12 patients with DAA and associated intracardiac defects were identified. There were 14 males and 10 females, with an average age of 11 months. The associated intracardiac malformations included ventricular septal defect (VSD), atrial septal defect (ASD), patent ductus arteriosus (PDA), tetralogy of Fallot (TOF), transposition of the great arteries (TGA), pulmonary stenosis (PS), and patent foramen ovale (PFO). Of the 12 patients with DAA and intracardiac malformations, 7 patients underwent intracardiac repair simultaneously, however, 3 patients underwent isolated double aortic arch correction. One patient with DAA and TGA underwent surgical correction of congenital vascular ring at the first stage, and the arterial switch operation was performed at the second stage. The clinical outcomes of 23 patients were promising, however, in one patient, parents decided not to do the surgery due to personal reasons. The average follow-up time was 35 months.
CONCLUSIONS
Tracheal and esophageal compression are commonly seen in patients with DAA, however could be relieved significantly after surgery. In particular cases, the simultaneous intracardiac defects repair could be performed. Misdiagnosis was easily established with isolated echocardiography. Fortunately, the correct diagnosis of DAA and associated intracardiac defects could be established with the use of combined chest computed tomography.
Topics: Aorta, Thoracic; Echocardiography; Female; Humans; Imaging, Three-Dimensional; Infant; Infant, Newborn; Male; Retrospective Studies; Tomography, X-Ray Computed; Treatment Outcome; Vascular Ring; Vascular Surgical Procedures
PubMed: 31500640
DOI: 10.1186/s13019-019-0976-x