-
The Journal of Thoracic and... May 2022
Topics: Aortic Dissection; Aortic Aneurysm, Thoracic; Blood Vessel Prosthesis Implantation; Endovascular Procedures; Humans; Treatment Outcome
PubMed: 32747117
DOI: 10.1016/j.jtcvs.2020.06.101 -
Circulation Journal : Official Journal... 2011
Topics: Acute Disease; Aortic Dissection; Aortic Aneurysm; Asymptomatic Diseases; Brain Ischemia; Cardiac Tamponade; Consciousness Disorders; Hemodynamics; Humans; Nervous System Diseases; Pain; Stroke; Syncope; Time Factors; Treatment Outcome
PubMed: 21173500
DOI: 10.1253/circj.cj-10-1149 -
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 -
Texas Heart Institute Journal 2011Two hundred fifty years have passed since Frank Nicholls' history-making, accurate observations on the anatomic findings and cause of death of King George II were... (Review)
Review
Two hundred fifty years have passed since Frank Nicholls' history-making, accurate observations on the anatomic findings and cause of death of King George II were published. Several decades later, the disease was named, using--for the first time--the terms dissection and dissecting attached to an aortic disease process. Another century went by before effective surgical treatment was developed. In sharp contrast, the evolution of the last 20 years has been nothing short of amazing. Our understanding of AD, while not yet complete, has improved dramatically. In addition, the introduction of nonsurgical endovascular therapy has had a profoundly transformative impact--and we are just at the beginning! It would not be unreasonable to predict that stent-graft repair will likely replace (or nearly replace) open surgery in the treatment of complicated type B dissection in the near future, especially as technologies continue to improve and indication-specific designs are developed and tested in the clinical setting. Moreover, it is predictable that endovascular solutions for some patients with type A aortic dissection will become available in the years to come as surgical results continue to be suboptimal. Finally, and amidst this plethora of “good news,” it is appropriate to reflect on the formidable challenge that endovascular therapies face as they gear to “compete” with optimal medical therapy in the management of patients with acute uncomplicated type B dissection, because it will obviously be difficult (if not impossible) to improve on the already-achieved 30-day mortality rate of less than 10%. Long-term gains may well become the winning card when and if the late results of TEVAR can be shown to improve on the rather compromised outlook of medically treated dissection patients. Stay tuned.
Topics: Aortic Dissection; Aortic Aneurysm; Blood Vessel Prosthesis Implantation; Endovascular Procedures; History, 18th Century; History, 19th Century; History, 20th Century; History, 21st Century; Humans; Vascular Surgical Procedures
PubMed: 22199439
DOI: No ID Found -
Methodist DeBakey Cardiovascular Journal 2011The biology of aortic aneurysm and dissection has evolved to where we now understand the genetic implications of changes in extracellular matrix proteins, smooth muscle... (Review)
Review
The biology of aortic aneurysm and dissection has evolved to where we now understand the genetic implications of changes in extracellular matrix proteins, smooth muscle cells, and growth factors and how they affect aortic wall homeostasis. These predeterminants are influenced by smoking, hypertension, and atherosclerosis, and the result in an inflammatory response coupled to an accelerated proteolytic cascade that disrupts both elastin and collagen in the aortic wall.
Topics: Aortic Dissection; Animals; Aorta; Aortic Aneurysm; Biomarkers; Extracellular Matrix Proteins; Genetic Predisposition to Disease; Humans; Oxidative Stress; Phenotype; Prognosis; Reactive Oxygen Species; Risk Factors
PubMed: 21979117
DOI: 10.14797/mdcj-7-3-2 -
Journal of the American Heart... Apr 2022
Topics: Aortic Dissection; Aortic Aneurysm, Thoracic; Humans; Pedigree; Risk Assessment
PubMed: 35383462
DOI: 10.1161/JAHA.122.025441 -
WMJ : Official Publication of the State... Sep 2020Recent studies have raised concerns that fluoroquinolone use is associated with an increased risk of aortopathy, including aortic aneurysm with and without dissection. (Meta-Analysis)
Meta-Analysis Review
INTRODUCTION
Recent studies have raised concerns that fluoroquinolone use is associated with an increased risk of aortopathy, including aortic aneurysm with and without dissection.
OBJECTIVE
We performed a meta-analysis with a comprehensive literature review to further investigate this association.
METHODS
This analysis was conducted per PRISMA guidelines. PubMed, Cochrane Library, ClinicalTrials.gov, Embase, Web of Science, and Google Scholar were searched for studies that included adult patients (age >18 years) exposed to fluoroquinolones or control antibiotics (amoxicillin/any other antibiotic) for urinary tract infection or pneumonia with a primary outcome of aortic aneurysm or dissection. Heterogeneity was calculated using Q statistic I.
RESULTS
A total of 6 studies-comprised of 59% males-were included in our analysis, which showed an increased combined risk of development of aortic aneurysm and aortic dissection with quinolone exposure when compared with controls (relative risk [RR] = 2.11; 95% CI, 1.62 - 2.75; I= 83.700). Individual relative risk for aortic aneurysm (RR = 2.83; 95% CI, 2.02 - 3.95, I = 89.150) and aortic dissection (RR = 1.99; 95% CI, 1.23 - 3.06; I2= 71.33) also were significantly increased.
CONCLUSION
Compared to other antibiotics, the use of fluoroquinolones was associated with a significantly higher risk of aortic aneurysm and dissection combined.
Topics: Adolescent; Adult; Aortic Dissection; Anti-Bacterial Agents; Aortic Aneurysm; Female; Fluoroquinolones; Humans; Male
PubMed: 33091293
DOI: No ID Found -
Interactive Cardiovascular and Thoracic... Jan 2021The goal was to evaluate outcomes after conservative or surgical treatment of acute aortic arch dissections.
OBJECTIVES
The goal was to evaluate outcomes after conservative or surgical treatment of acute aortic arch dissections.
METHODS
Between January 2009 and December 2018, patients with a diagnosis of acute aortic dissection were analysed. Aortic arch aortic dissection was defined as a dissection with an isolated entry tear at the aortic arch with no involvement of the ascending aorta.
RESULTS
Aortic arch dissection was diagnosed in 31 patients (age 59 ± 11 years). Surgical intervention was performed in 13 (41.9%) cases. Overall in-hospital mortality was 3% (n = 1), and all deaths occurred in the conservative group (n = 1; 6%), whereas the overall stroke rate was 3% (n = 1), and all strokes occurred in the group treated surgically (n = 1; 8%). Surgical repair was necessary for the following conditions: end-organ malperfusion (n = 9; 69%), impending rupture (n = 3; 23%) and dilatation of the aorta with ongoing pain refractory to medical treatment (n = 1; 8%). Overall survival at the end of the follow-up period was 71%, with 77% in the surgical group and 63% in the conservative group (P = 0.91). Freedom from surgical intervention was 71%, with 82% in the surgical and 63% in the conservative group (P = 0.21), and freedom from a neurological event was 88%, with 89% versus 89% (P = 0.68) in the surgical and conservative groups, respectively.
CONCLUSIONS
Aortic arch dissection is a rare pathological condition that is one of the most challenging decision-making entities. Patients manifesting an uneventful course not requiring a surgical intervention during a hospital stay were at a higher risk for aorta-related intervention during the follow-up period. The treatment modality had no impact on survival or on the incidence of a neurological event.
Topics: Acute Disease; Aged; Aortic Dissection; Aorta, Thoracic; Female; Hospital Mortality; Humans; Kaplan-Meier Estimate; Male; Middle Aged; Treatment Outcome
PubMed: 33221851
DOI: 10.1093/icvts/ivaa228 -
Internal Medicine (Tokyo, Japan) Jan 2022
Topics: Abdomen; Aortic Dissection; Aneurysm, False; Humans; Stomach
PubMed: 34275985
DOI: 10.2169/internalmedicine.7715-21 -
The Journal of Thoracic and... Nov 2021
Topics: Aortic Dissection; Aortic Aneurysm, Thoracic; Humans
PubMed: 32284145
DOI: 10.1016/j.jtcvs.2020.02.115