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BMJ Open Feb 2021Thoracic endovascular aortic repair (TEVAR) has gradually become the mainstream therapy for aortic arch pathologies (AAP). Our centre developed the in situ fenestration...
Evaluation for the safety and effectiveness of the in situ fenestration system in TEVAR for aortic arch pathologies: protocol for a prospective, multicentre and single-arm study.
INTRODUCTION
Thoracic endovascular aortic repair (TEVAR) has gradually become the mainstream therapy for aortic arch pathologies (AAP). Our centre developed the in situ fenestration (ISF) system according to years of clinical experience and technological innovation. This study aims to evaluate the safety and effectiveness of the innovative, self-developed ISF system in TEVAR for AAP.
METHODS AND ANALYSIS
The study is a prospective, multicentre and single-arm study. Patients diagnosed with AAPs in five centres on 1 January 2021 will be recruited and general TEVAR with ISF system will be performed. Clinical information and CT angiography images will be collected and recorded. Patients will be followed up for 5 years. Safety and efficacy endpoints are planned to be reported to evaluate this self-developed ISF system.
ETHICS AND DISSEMINATION
The study is a registry. We have registered the study on the Chinese Clinical Trial Registry website (http://www.chictr.org.cn/). This study has been approved by the Ethics Committee of Zhongshan Hospital Fudan University (B2020-371) and individual consents will be signed at the time of enrolment. We anticipate that this self-developed ISF system will result in favourable social and economic benefits. Findings will be disseminated in peer-reviewed journals to provide reference for future clinical practice.
TRIAL REGISTRATION NUMBER
ChiCTR1900026696.
Topics: Aorta, Thoracic; Aortic Aneurysm, Thoracic; Endovascular Procedures; Humans; Multicenter Studies as Topic; Prospective Studies; Retrospective Studies; Stents; Treatment Outcome
PubMed: 33619193
DOI: 10.1136/bmjopen-2020-043599 -
European Journal of Vascular and... Feb 2019
Editor's Choice - Current Options and Recommendations for the Treatment of Thoracic Aortic Pathologies Involving the Aortic Arch: An Expert Consensus Document of the European Association for Cardio-Thoracic Surgery (EACTS) & the European Society for Vascular Surgery (ESVS).
Topics: Aortic Dissection; Aorta, Thoracic; Aortic Aneurysm, Thoracic; Computed Tomography Angiography; Humans; Magnetic Resonance Imaging; Vascular Surgical Procedures
PubMed: 30318395
DOI: 10.1016/j.ejvs.2018.09.016 -
Fetal Diagnosis and Therapy 2024The prenatal detection rate of a right aortic arch (RAA) has increased with the implementation of the three-vessel view (3VV) to the second-trimester anomaly scan formed...
INTRODUCTION
The prenatal detection rate of a right aortic arch (RAA) has increased with the implementation of the three-vessel view (3VV) to the second-trimester anomaly scan formed by the pulmonary artery (PA), aorta (Ao), and superior vena cava (SVC). We examined the value of measuring the distance between PA and Ao in the 3VV in cases with an RAA.
METHODS
We conducted a case-control study in which fetuses with an isolated RAA were matched to 3 healthy controls. Using 3VV images, the distances between PA, Ao, and SVC were measured and the ratio between PA to Ao (PAAo) distance and Ao to SVC (AoSVC) distance was calculated.
RESULTS
Fifty-four RAA cases and 162 matched controls were included. The mean absolute distance PAAo was 3.1 mm in cases and 1.8 mm in controls (p < 0.001), and the mean PAAo/AoSVC ratio was 2.9 and 1.4, respectively (p < 0.001). The ROC curve of PAAo/AoSVC ratio showed a cut-off point of 1.9 with sensitivity and specificity over 87% for the diagnosis of RAA.
CONCLUSIONS
The pulmonary-aortic interspace and the PAAo/AoSVC ratio were significantly larger for RAA cases as compared to controls. If an increased pulmonary-aortic interspace is observed, a PAAo/AoSVC of ≥1.9 can be helpful in the diagnosis of an RAA.
Topics: Humans; Female; Case-Control Studies; Pregnancy; Aorta, Thoracic; Pulmonary Artery; Ultrasonography, Prenatal; Adult; Vena Cava, Superior
PubMed: 38272013
DOI: 10.1159/000536403 -
Journal of Cardiothoracic Surgery Dec 2022Aortic arch injuries account for about 8% of thoracic aortic injuries. Penetrating zone I neck injuries account for 18% of vascular injuries in the neck and have great... (Review)
Review
BACKGROUND
Aortic arch injuries account for about 8% of thoracic aortic injuries. Penetrating zone I neck injuries account for 18% of vascular injuries in the neck and have great potential to traverse to involve thoracic vascular structures as well. The hard and soft signs of vascular injury facilitate triage of patients on an individual basis. We present a case of a ball-point pen traversing through zone I of the neck and causing penetrating aortic arch injury with minimal mediastinal haemorrhage.
CASE PRESENTATION
We present a polytrauma patient who was admitted with traumatic brain injury and a ball-point pen lodged above the sternal notch in zone I of the neck following a road traffic accident. He underwent mediastinal exploration via a median sternotomy. The ball-point pen was found penetrating the anterior wall of the aortic arch and resting in its lumen. The ball-point pen was successfully explanted and primary repair of the penetrating aortic arch injury was done. He had an uneventful recovery without any added secondary neurological complications.
CONCLUSION
Penetrating aortic arch injuries are rare compared to injuries of the ascending aorta and descending aorta. They require a high index of suspicion, rapid investigation and urgent intervention in view of their high associated fatality. The ball-point pen in this case assumed the shape of a plug which acted as a seal at the site of injury preventing catastrophic exsanguination.
Topics: Male; Humans; Aorta, Thoracic; Wounds, Penetrating; Aorta; Thoracic Injuries; Vascular System Injuries; Aortic Aneurysm, Thoracic; Blood Vessel Prosthesis Implantation
PubMed: 36522761
DOI: 10.1186/s13019-022-02057-5 -
The Journal of International Medical... Feb 2020This study was performed to describe the treatment of aortic arch pathologies with a physician-modified fenestration (PMF) technique in thoracic endovascular aortic...
OBJECTIVE
This study was performed to describe the treatment of aortic arch pathologies with a physician-modified fenestration (PMF) technique in thoracic endovascular aortic repair (TEVAR).
METHODS
From August 2015 to August 2017, 32 patients with aortic arch pathologies underwent TEVAR with the PMF technique. All patients' clinical data were analyzed with GraphPad Prism 7.0.
RESULTS
Thirty-four aortic stent-grafts were implanted in 32 patients. The mean proximal diameter of the stent-graft was 32.4 ± 3.4 cm, and the mean length was 170.0 ± 25.2 cm. Twenty-nine PMF procedures were performed to preserve the left subclavian artery (LSA) and three to preserve both the LSA and left common carotid artery. The mean distance between the pathology and LSA was 8.4 ± 4.0 mm. The mean procedure time (from first to last digital subtraction angiography) was 22.8 ± 20.8 min. The mean follow-up time was 8.3 ± 5.3 months. During follow-up, the all-cause survival rate was 83.3% and the patency rate of the branch artery after PMF was 96.0%.
CONCLUSION
The PMF technique is a relatively safe, feasible, and time-saving method to preserve the branch artery in TEVAR for aortic arch pathologies. The short- to middle-term result of this technique is satisfactory.
Topics: Aorta, Thoracic; Blood Vessel Prosthesis; Blood Vessel Prosthesis Implantation; Endovascular Procedures; Humans; Physicians; Retrospective Studies; Treatment Outcome
PubMed: 31547732
DOI: 10.1177/0300060519870903 -
Folia Morphologica May 2013The most reliable data about arterial variations, which are very important in surgery and radiology, can be obtained from a large series of patients.
BACKGROUND
The most reliable data about arterial variations, which are very important in surgery and radiology, can be obtained from a large series of patients.
MATERIALS AND METHODS
We examined angiographic and multislice computerised tomography (MSCT) images in a group of 1,265 patients and in 1 dissected specimen.
RESULTS
While in 946 (74.72%) of the patients a normal vascular pattern (type I) was noticed, in the remaining 320 (25.28%) patients variations of the branches of the aortic arch were found, which were classified into types II through VIII and a few subtypes. Type II (2.84%) comprised a common origin of the left commoncarotid and subclavian arteries. Type III (15.56%) was related to an origin of the left subclavian artery from the brachiocephalic trunk. Type IV (0.55%) included the aortic origin of both common carotid and subclavian arteries, with the right subclavian artery having a retroesophageal course. Type V (0.24%) included the same 4 supra-aortic branches, which, however, arose from a double or a right--sided aortic arch. Type VI (3.63%) comprised the aortic origin of the left vertebral artery, type VII (0.24%) the same origin of the right vertebral artery, and type VIII(2.22%) the aortic origin of the thyroideaima artery. A corresponding embryological background and clinical implications of the described aberrant vessels were presented.
CONCLUSIONS
In more than one quarter of the cases, the branching pattern of the examined arteries did not follow the classical pattern. Detailed knowledge of aortic branch variations is of great significance in anatomy, embryology, and clinical medicine, especially in radiology and thoracic surgery.
Topics: Aged; Angiography; Aorta, Thoracic; Female; Humans; Male
PubMed: 23740497
DOI: 10.5603/fm.2013.0019 -
European Journal of Cardio-thoracic... Apr 2012To analyse the technique of neonatal aortic arch enlargement without cardiopulmonary bypass through a left posterior thoracotomy, as an adjunct to extended resection for...
OBJECTIVE
To analyse the technique of neonatal aortic arch enlargement without cardiopulmonary bypass through a left posterior thoracotomy, as an adjunct to extended resection for Coarctation and severe arch hypoplasia.
METHODS
Ten neonates with coarctation, severe arch hypoplasia and a persistent ductus arteriosus (PDA) were subjected to arch repair through a left posterior thoracotomy. Nine of these patients had associated significant intracardiac anomalies; three of them received pulmonary artery (PA) banding. After exclusion from circulation, the roof of the intervening arch between left carotid and left subclavian was enlarged using a patch. After adequate reperfusion, a classic resection and extended end-to-end anastomosis was performed. Median age and weight were 5.5 (1-10) days and 3.3 (2.2-4.1) kg respectively. The median preoperative arch diameter was 1.07 (0.75-1.32) mm/kg body weight.
RESULTS
All patients could be successfully operated with this approach. The non-ischaemic and ischaemic aortic clamp times were 40 (15-68) and 23 (18-32) min, respectively. The median postoperative arch diameter achieved was 1.43 (1.06-1.46) mm/kg body weight. None of the patients had significant gradient early postoperatively. Two patients with recurrent stenosis were successfully treated with balloon dilatation (1) or surgery with cardiopulmonary bypass (CPB) (1). One patient has a corrected gradient of 16 mmHg in the proximal arch which is being observed. The remaining patients are free from stenosis at a median follow-up of 30.1 (13.2-57.8) months.
CONCLUSIONS
Use of PDA for lower body perfusion allows complex reconstruction of the arch without incurring lower body ischaemia. The extended resection could then be performed without excessive stretch. This modification saves these patients from undergoing a complex arch reconstruction with CPB in the early neonatal period.
Topics: Aorta, Thoracic; Aortic Coarctation; Cardiopulmonary Bypass; Ductus Arteriosus, Patent; Heart Defects, Congenital; Humans; Infant, Newborn; Magnetic Resonance Imaging; Pericardium; Postoperative Complications; Regional Blood Flow; Spinal Cord Ischemia; Thoracotomy; Ultrasonography
PubMed: 22219416
DOI: 10.1093/ejcts/ezr110 -
Circulation Research Apr 2010Apolipoprotein E-null mice with a 129S6/SvEvTac strain background (129-apoE) develop atherosclerotic plaques faster in the aortic arch but slower in the aortic root than... (Comparative Study)
Comparative Study
RATIONALE
Apolipoprotein E-null mice with a 129S6/SvEvTac strain background (129-apoE) develop atherosclerotic plaques faster in the aortic arch but slower in the aortic root than those with a C57BL/6J background (B6-apoE). The shape of the aortic arch also differs in the 2 strains.
OBJECTIVE
Because circulating plasma factors are the same at both locations, we tested the hypothesis that genetic factors affecting vascular geometry also affect the location and extent of atherosclerotic plaque development.
METHODS AND RESULTS
Tests on the F2 progeny from a cross between 129-apoE-null and B6-apoE-null mice showed that the extent of atherosclerosis in the aortic arch is significantly correlated in males, but not in females, with the shape of arch curvature (r=0.34, P<0.0001) and weakly with the arch diameter (r=0.20, P=0.02). Quantitative trait locus (QTL) analysis identified 2 significant peaks for aortic arch lesion size on chromosome 1 (105 Mb, LOD=5.0, and 163 Mb, LOD=6.8), and a suggestive QTL on chromosome 15 (96 Mb, LOD=4.7). A significant QTL for aortic root lesion size was on chromosome 9 (61 Mb, LOD=6.9), but it was distinct from the QTLs for arch lesion size. Remarkably, the QTLs for susceptibility to atherosclerosis in the arch overlapped with a significant QTL that affects curvature of the arch on chromosome 1 (121 Mb, LOD=5.6) and a suggestive QTL on chromosome 15 (76 Mb, LOD=3.5).
CONCLUSIONS
The overlapping QTLs for curvature of the aortic arch and atherosclerosis support that the ontogeny of the aortic arch formation is a potential risk factor for atherosclerosis.
Topics: Animals; Aorta, Thoracic; Apolipoproteins E; Atherosclerosis; Chromosomes, Mammalian; Crosses, Genetic; Disease Models, Animal; Female; Gene Expression Regulation, Developmental; Genetic Predisposition to Disease; Heredity; Lipids; Male; Mice; Mice, Inbred C57BL; Mice, Knockout; Pedigree; Phenotype; Quantitative Trait Loci; Risk Factors; Species Specificity
PubMed: 20133902
DOI: 10.1161/CIRCRESAHA.109.207175 -
Ultrasound in Obstetrics & Gynecology :... Mar 2000To establish in-utero reference ranges for fetal transverse aortic arch diameter (TAD) and distal aortic isthmus diameter (DAID) using high-resolution ultrasound... (Clinical Trial)
Clinical Trial
OBJECTIVE
To establish in-utero reference ranges for fetal transverse aortic arch diameter (TAD) and distal aortic isthmus diameter (DAID) using high-resolution ultrasound techniques.
DESIGN
A prospective, cross-sectional study was performed on 125 normal singleton pregnancies between 14 and 38 weeks' gestation. Transverse and diameter and DAID were measured by transvaginal ultrasonography until 17 weeks' gestation, and by abdominal ultrasound between 18 and 38 weeks' gestation.
RESULTS
Transverse arch diameter as a function of gestational age was expressed by the regression equation TAD = -1.17 + 0.169 X GA, and DAID = -1.39 + 0.189 X GA; TAD and DAID are transverse aortic and distal aortic isthmus diameters expressed in millimeters and GA is gestational age in weeks. The correlation r = 0.924 and 0.938 was found to be highly statistically significant (P < 0.001) for TAD and DAID. The normal mean of TAD and DAID per week and the 95% prediction limits were also defined.
CONCLUSIONS
The normative data established by us may be helpful in the prenatal diagnosis of congenital heart defects, including abnormal growth of the aortic arch.
Topics: Adult; Aorta, Thoracic; Confidence Intervals; Cross-Sectional Studies; Embryonic and Fetal Development; Female; Heart Defects, Congenital; Humans; Linear Models; Pregnancy; Pregnancy Trimester, First; Pregnancy Trimester, Second; Pregnancy Trimester, Third; Prospective Studies; Reference Values; Sensitivity and Specificity; Ultrasonography, Doppler; Ultrasonography, Prenatal
PubMed: 10846779
DOI: 10.1046/j.1469-0705.2000.00068.x -
Kardiologia Polska 2022
Topics: Aorta, Thoracic; Aortic Coarctation; Heart Septal Defects, Ventricular; Humans; Infant; Treatment Outcome
PubMed: 34981826
DOI: 10.33963/KP.a2022.0003