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Seminars in Roentgenology Oct 2022Chronic aortic dissection comprises a heterogeneous group of unrepaired and repaired disease requiring lifelong clinical and imaging surveillance. CT and MRI are the... (Review)
Review
Chronic aortic dissection comprises a heterogeneous group of unrepaired and repaired disease requiring lifelong clinical and imaging surveillance. CT and MRI are the main imaging modalities for longitudinal surveillance, with growing interest in emerging imaging techniques for prognostic potential. Imaging difficulties span technical and diagnostic challenges, some of which are unique to the repaired aorta, with specific complications depending on the type of repair. This review describes existing and emerging imaging techniques, outlines the technical and diagnostic challenges encountered at CT and MRI, and highlights the diagnostic pitfalls of chronic aortic dissection.
Topics: Humans; Aortic Dissection; Magnetic Resonance Imaging
PubMed: 36265986
DOI: 10.1053/j.ro.2022.06.002 -
BMC Cardiovascular Disorders Oct 2022The incidence and mortality of aortic dissection (AD) are increasing. In pathological studies, macrophages, T lymphocytes and dendritic cells were found in the tunica...
BACKGROUND
The incidence and mortality of aortic dissection (AD) are increasing. In pathological studies, macrophages, T lymphocytes and dendritic cells were found in the tunica media of the aorta. Acetaldehyde dehydrogenase 2 (ALDH) gene polymorphisms are associated with a high incidence of hypertension in Asian populations. However, there is no clear evidence of the relationship between ALDH and aortic dissection in Asians. The aim of this study was to investigate the incidence of aortic dissection in different ALDH genotypes and explore changes in the vasculature.
MATERIALS AND METHODS
Three-week-old male mice were administered freshly prepared β-aminopropionitrile solution dissolved in drinking water (1 g/kg/d) for 28 days to induce TAD. An animal ultrasound imaging system was used to observe the formation of arterial dissection and changes in cardiac function. Subsequently, mice were euthanized by cervical dislocation. The aortas were fixed for HE staining and EVG staining to observe aortic elastic fiber tears and pseudoluma formation under a microscope.
RESULTS
Knockout of ALDH mitigated β-aminopropionitrile-induced TAD formation in animal studies. Ultrasound results showed that ALDH knockout reduced the degree of ascending aortic widening and the incidence of aortic dissection rupture. Pathological sections of multiple aortic segments showed that the protective effect of ALDH knockout was observed in not only the ascending aorta but also the aortic arch and descending aorta. The expression levels of genes related to NK CD56bright cells, Th17 cells, T cells and T helper cells were decreased in ALDH knockout mice treated with β-aminopropionitrile for 28 days.
CONCLUSION
ALDH knockout protects against aortic dissection by altering the inflammatory response and immune response and protecting elastic fibers.
Topics: Aldehyde Dehydrogenase, Mitochondrial; Aminopropionitrile; Aortic Dissection; Animals; Aortic Aneurysm, Thoracic; Aortic Rupture; Disease Models, Animal; Drinking Water; Male; Mice; Mice, Inbred C57BL; Mice, Knockout
PubMed: 36229771
DOI: 10.1186/s12872-022-02874-5 -
Vascular Medicine (London, England) Jun 2016Aortic dissection remains a challenging clinical scenario, especially when complicated by peripheral malperfusion. Improvements in medical imaging have furthered... (Review)
Review
Aortic dissection remains a challenging clinical scenario, especially when complicated by peripheral malperfusion. Improvements in medical imaging have furthered understanding of the pathophysiology of malperfusion events in association with aortic dissection, including the elucidation of different mechanisms of branch vessel obstruction. Despite these advances, malperfusion syndrome remains a deadly entity with significant mortality. This review presents the latest knowledge regarding the pathogenesis of aortic dissection complicated by malperfusion syndrome, and discusses the diagnostic and therapeutic guidelines for management of this vicious entity.
Topics: Aortic Dissection; Animals; Aortic Aneurysm; Aortography; Blood Vessel Prosthesis; Blood Vessel Prosthesis Implantation; Endovascular Procedures; Hemodynamics; Humans; Ischemia; Regional Blood Flow; Stents; Treatment Outcome; Ultrasonography, Doppler, Color; Vascular Patency
PubMed: 26858183
DOI: 10.1177/1358863X15625371 -
Seminars in Vascular Surgery Mar 2022Although the topics of surgical techniques and medical therapies have been widely studied in aortic dissection (AD), studies examining the short- and long-term impact of... (Review)
Review
Although the topics of surgical techniques and medical therapies have been widely studied in aortic dissection (AD), studies examining the short- and long-term impact of this event on mental health are largely lacking. Many of the studies have used the 36-Item Short Form Survey at variable time points after the event. However, AD as medical trauma has a complex impact on a person's identity. Its implications for emotional, mental, social, existential, and self-concept could be explored more robustly. This topic was identified as a topic of interest by the AD Collaborative. The AD Collaborative Mental Health Working Group was formed and performed a landscape review to summarize current literature surrounding quality of life research in those who have experienced AD, identify gaps in knowledge, and to outline future research questions.
Topics: Aortic Dissection; Humans; Mental Health; Quality of Life; Surveys and Questionnaires
PubMed: 35501046
DOI: 10.1053/j.semvascsurg.2022.02.005 -
JACC. Cardiovascular Imaging Apr 2014Aortic aneurysm and acute aortic syndrome are not uncommon conditions. Management of acute aortic dissection and related syndromes requires a multidisciplinary approach... (Review)
Review
Aortic aneurysm and acute aortic syndrome are not uncommon conditions. Management of acute aortic dissection and related syndromes requires a multidisciplinary approach with input from the patient, clinician, imager, surgeon, and anesthesiologist. This requires an integrated evaluation of pathophysiology, anatomy, and severity to enable appropriate therapy. This review includes discussion of essential anatomy of the aortic valve and the aorta that determines the candidacy for surgical repair. It also includes discussion of various imaging modalities, particularly echocardiography, cardiac computed tomography, and cardiac magnetic resonance angiography. The relative benefits and demerits of each of these techniques are reviewed. This paper is intended to help guide management decisions for patients with acute aortic dissection and related syndromes.
Topics: Algorithms; Aortic Dissection; Aortic Aneurysm; Aortography; Critical Pathways; Diagnostic Imaging; Echocardiography; Humans; Magnetic Resonance Angiography; Predictive Value of Tests; Prognosis; Syndrome
PubMed: 24742892
DOI: 10.1016/j.jcmg.2013.10.015 -
The Journal of Thoracic and... Aug 2021
Topics: Aortic Dissection; Aortic Aneurysm, Thoracic; Humans
PubMed: 32532502
DOI: 10.1016/j.jtcvs.2020.04.119 -
Journal of Vascular Surgery May 2022Acute type A aortic dissection (ATAAD) is a critical disease presenting with disseminated intravascular coagulation (DIC). However, the relationship between the degree...
OBJECTIVE
Acute type A aortic dissection (ATAAD) is a critical disease presenting with disseminated intravascular coagulation (DIC). However, the relationship between the degree of DIC and false lumen conditions remains unclear. In the present study, we evaluated the degree of preoperative DIC and the outcomes of ATAAD treatment.
METHODS
A total of 124 patients with ATAAD (70 men and 54 women) treated from January 2012 to January 2020 were included in the present study. The correlation between the preoperative Japanese Association for Acute Medicine (JAAM) DIC score and the false lumen diameter and length, measured using preoperative computed tomography, was examined retrospectively. The correlations were calculated using liner regression analysis. The level of statistical significance was set at P < .05.
RESULTS
The patients were divided into two groups: a low JAAM DIC score group and a high JAAM DIC score group. The preoperative JAAM DIC scores in the high- and low-score groups were 4.8 ± 1.2 and 1.7 ± 2.3, respectively (P < .001). The 5-year survival rates and aortic event-free rates in the low-score group were favorable compared with the high-score group; however, the differences were not statistically significant (80.8% vs 54.5%, P = .065; 63.9% vs 59.8%, P = .15, respectively). The false lumen diameter in the ascending aorta was greater in the high-score group than that in the low-score group (P < .05). The JAAM DIC score correlated significantly with the ascending false lumen diameter and the dissection length (r = 0.32 and P < .001; r = 0.29 and P = .001, respectively). A high JAAM DIC score was associated with communicating-type ATAAD (P < .05).
CONCLUSIONS
Our results suggest that high preoperative JAAM DIC scores are associated with a large false lumen and communicating-type ATAAD.
Topics: Aortic Dissection; Disseminated Intravascular Coagulation; Female; Humans; Male; Retrospective Studies
PubMed: 34998941
DOI: 10.1016/j.jvs.2021.12.064 -
Annals of Thoracic and Cardiovascular... Jun 2022To analyze the results of hemoadsorption in patients with cardiac surgery to thoracic aortic surgery, who had been loaded beforehand with either Factor Xa inhibitor...
OBJECTIVE
To analyze the results of hemoadsorption in patients with cardiac surgery to thoracic aortic surgery, who had been loaded beforehand with either Factor Xa inhibitor rivaroxaban or P2Y12 receptor antagonist ticagrelor.
METHODS
We investigated 21 of 171 consecutive patients (median age 71 [interquartile range 62, 76] years) who underwent emergency cardiac operations for acute type A aortic dissection between 2014 and 2020. These patients were pretreated with rivaroxaban (n = 9) or ticagrelor (n = 12). In ten of 21 cases (since 2017), we installed a hemoadsorber into the heart-lung machine and compared the results to eleven patients done without hemoadsorber before that time.
RESULTS
The operation time was significantly shorter in the adsorber group (286 ± 40 min vs. 348 ± 79 min; p = 0.045). The postoperative 24-hour drainage volume was significantly lower after adsorption (p <0.001; 482 ± 122 ml vs. 907 ± 427 ml) and no rethoracotomy had to be performed (compared to two rethoracotomies [18.9%] among patients without adsorber use). Also, patients without hemoadsorption required significantly more platelet transfusions (p = 0.049).
CONCLUSIONS
In patients with acute type A aortic dissection who were pretreated with rivaroxaban and ticagrelor, the intraoperative use of CytoSorb hemoadsorption during cardiopulmonary bypass is reported for the first time. The method was found to be effective to prevent from bleeding and to improve the outcome in aortic dissection.
Topics: Aortic Dissection; Aortic Aneurysm, Thoracic; Cardiac Surgical Procedures; Humans; Rivaroxaban; Ticagrelor; Treatment Outcome
PubMed: 35046210
DOI: 10.5761/atcs.oa.21-00154 -
Interactive Cardiovascular and Thoracic... Oct 2022Aortic wrapping is a controversial repair in patients presenting with acute type A aortic dissection or intramural haematoma, but this method may be a potential...
Aortic wrapping is a controversial repair in patients presenting with acute type A aortic dissection or intramural haematoma, but this method may be a potential alternative to medical treatment or conventional repair in patients aged >80 years and in those presenting with prohibitive co-morbidities such as stroke, circulatory collapse, full oral anticoagulation with the last generation drugs. We report on 5 high-risk and/or patients over 80 years who received external aortic wrapping with or without cardiopulmonary bypass during the last 18 months. All survived the procedure and could be extubated early postoperatively. No patient remained on the intensive care longer than 2 days and all were discharged without additional complications. Postoperative radiological control was acceptable and no patient had any new aortic event up to 18 months postoperatively.
Topics: Humans; Aortic Dissection; Hematoma; Aorta; Cardiopulmonary Bypass; Anticoagulants; Treatment Outcome; Aortic Aneurysm, Thoracic
PubMed: 36205640
DOI: 10.1093/icvts/ivac254 -
Seminars in Vascular Surgery Mar 2022Aortic dissection (AD) is recognized as a potentially fatal condition and its standard treatment has been surgical intervention for acute type A AD (TAAD) and... (Review)
Review
Aortic dissection (AD) is recognized as a potentially fatal condition and its standard treatment has been surgical intervention for acute type A AD (TAAD) and complicated acute type B AD (TBAD), and medical management for uncomplicated acute type B AD. Due to rapidly evolving device technologies and minimally invasive surgical techniques that have lowered perioperative risk, there are paradigm shifts for the indications and treatment options for both TAAD and TBAD. In this article, we will discuss the current indications and treatment options for TAAD and TBAD by chronicity of the disease, which comprises four categories: acute TAAD, chronic (repaired) TAAD, acute TBAD, and chronic TBAD. We will also discuss the knowledge gaps in the current surgical management strategies and literature evidence. Open surgical intervention remains the reference standard for acute TAAD and chronic TAAD with complications until an endoprosthesis that will suit the complex anatomy of aortic root, ascending aorta, and aortic arch is developed. Thoracic endovascular aortic repair is now the first line for complicated acute and chronic TBADs. However, we need a larger trials to support the safety and durability of the procedures in patients with uncomplicated TBAD. Without additional data, patients are left to choose between existing treatment options, such as open surgical repair and stent-grafting.
Topics: Aortic Dissection; Aorta; Aorta, Thoracic; Endovascular Procedures; Humans; Stents
PubMed: 35501039
DOI: 10.1053/j.semvascsurg.2022.02.009