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Diagnostic and Interventional Imaging Jan 2015Isthmic aortic rupture or disruption should be systematically sought when there is high kinetic energy trauma to the thorax. This condition is extremely serious and life...
Isthmic aortic rupture or disruption should be systematically sought when there is high kinetic energy trauma to the thorax. This condition is extremely serious and life threatening. It needs to be diagnosed rapidly but diagnostic pitfalls must be avoided. CT angiography is the standard examination. The main CT signs of rupture or disruption of the thoracic aorta are periaortic hematoma, intimal flap, pseudo-aneurysm and contrast agent extravasation. There are three types of lesion: intimal, subadventitial or pseudo-aneurysmal, and complete rupture with lesion of the three tunicae, and it is important to grade them for better therapeutic management. The main diagnostic pitfalls of the CT scan are the presence of a ductus diverticulum and post-isthmic fusiform dilatation. Associated lesions must not be overlooked. The most common are ruptures of the aortic root and the thoracic aorta in the diaphragmatic hiatus.
Topics: Angiography; Aorta, Thoracic; Humans; Tomography, X-Ray Computed; Vascular System Injuries
PubMed: 25540927
DOI: 10.1016/j.diii.2014.02.003 -
The Journal of Thoracic and... Nov 2008Vascular remodeling within the aorta results in a loss of structural integrity with consequent aneurysm formation. This degradation is more common in the abdominal aorta... (Review)
Review
Vascular remodeling within the aorta results in a loss of structural integrity with consequent aneurysm formation. This degradation is more common in the abdominal aorta but also occurs above the diaphragm in the thoracic aorta. Conventionally, the aorta has been considered a large vascular conduit with uniform cellular and extracellular structure and function. Evidence is accumulating, however, to suggest that variations exist between the thoracic and abdominal aorta, thereby demonstrating regional heterogeneity. Further pathophysiologic studies of aortic dilation in each of these regions have identified disparities in atherosclerotic plaque deposition, vessel mechanics, protease profiles, and cell-signaling pathways. Improved understanding of this spatial heterogeneity might promote evolution in the management of aneurysm disease through computational models of aortic wall stress, imaging of proteolytic activity, targeted pharmacologic treatment, and application of region-specific gene therapy.
Topics: Aorta, Abdominal; Aorta, Thoracic; Aortic Aneurysm, Abdominal; Aortic Aneurysm, Thoracic; Humans
PubMed: 19026791
DOI: 10.1016/j.jtcvs.2008.06.027 -
European Journal of Vascular and... Jan 2017
Topics: Aorta, Thoracic; Aortic Diseases; Endovascular Procedures; Humans; Practice Guidelines as Topic
PubMed: 28081801
DOI: 10.1016/j.ejvs.2016.06.015 -
The Journal of Thoracic and... Nov 2021
Topics: Aorta, Thoracic; Humans
PubMed: 32171484
DOI: 10.1016/j.jtcvs.2020.02.061 -
PloS One 2019Aging changes the aorta in length, tortuosity and diameter. This is relevant in thoracic endovascular aortic repair (TEVAR) and in the long term follow up.
BACKGROUND
Aging changes the aorta in length, tortuosity and diameter. This is relevant in thoracic endovascular aortic repair (TEVAR) and in the long term follow up.
METHODS AND RESULTS
Two groups of hundred patients < 65 years and hundred patients ≥ 65 years, with no vascular diseases were made. Thin cut CT scans were analyzed with 3Mensio Vascular software and the following measurements were collected; tortuosity index, curvature ratio, maximum tortuosity in degrees and the level of vertebrae of the maximum tortuosity. The descending thoracic aorta (DTA) was analyzed and was divided into four zones of equal length. Subjects were divided into three groups based on their maximum tortuosity value: low (< 30°), moderate (30° - 60°) and high (> 60°). A linear regression model was built to test the effect of age and gender on tortuosity. Tortuosity was more pronounced in the ≥ 65 compared to the < 65 group (tortuosity index: 1.05 vs. 1.14, respectively; p < 0.001), curvature ratio (1.00 vs. 1.01; p < 0.001), maximum tortuosity (22.24 vs. 27.26; p < 0.001), and group of angulation (low vs. low; p < 0.001). Additionally, the location of maximum tortuosity was further distal for the ≥ 65 group (level of vertebrae; 5.00 vs. 5.00; p < 0.001), and zone of maximum tortuosity (4A vs. 4A; p < 0.001). There was no significant difference between male and female subjects.
CONCLUSION
Normal DTA tortuosity increases with age. This is important to understand natural aging and for TEVAR planning and follow-up.
Topics: Adult; Age Factors; Aged; Aged, 80 and over; Aging; Aorta, Thoracic; Aortic Diseases; Blood Vessel Prosthesis Implantation; Endovascular Procedures; Female; Healthy Volunteers; Humans; Imaging, Three-Dimensional; Male; Middle Aged; Reference Values; Retrospective Studies; Sex Factors; Stents; Tomography, X-Ray Computed
PubMed: 31013307
DOI: 10.1371/journal.pone.0215549 -
The Journal of Cardiovascular Surgery Jun 2022
Topics: Aortic Dissection; Aorta, Thoracic; Aortic Aneurysm, Thoracic; Humans; Treatment Outcome
PubMed: 35343662
DOI: 10.23736/S0021-9509.22.12332-3 -
Ulusal Travma Ve Acil Cerrahi Dergisi =... May 2021To describe gender-related differences in the length of the left chord and pedicle at the level of 12th thoracic vertebrae and appropriate length of the screw to be...
BACKGROUND
To describe gender-related differences in the length of the left chord and pedicle at the level of 12th thoracic vertebrae and appropriate length of the screw to be applied so as to decrease the perforation risk of anterior cortex of the corpus and preventable injury of major vascular vessels.
METHODS
Axial bone window computed tomography images of T12 vertebral pedicles of 60 patients (30 males and 30 females, age >25 years) without any sign of spinal trauma were obtained and morphometric data were analyzed.
RESULTS
Mean ages of the female (n=30) and male (n=30) patients were 32.17±4.24 and 31.70±3.60 years, respectively. The left chord lengths of T12 of the male (38.17±2.54 mm) and female (36.62±2.27 mm) patients were compared and a statistically significant difference was found between these two measurements (p=0.016). A statistically significant difference between the length of the left chord (37.40±2.51) (range, 32-44 mm) and age (31.93±3.91) (range, 25-40 years) and also a moderate degree of correlation were observed (p=0.002), (r=0.401). A statistically significant difference and a moderate degree of correlation were found between the lengths of the left chords (37.40±2.51; range, 32-44 mm) and the left pedicles (12.12±1.34; range, 10.0-15.80 mm) (p=0.001), (r=0.577).
CONCLUSION
Significant differences and correlations exist between the left pedicle and the left chord in male and female patients and patients with different ages. The data obtained can be used as a guide to determine the implant size and intraoperative management of T12 vertebral pedicle.
Topics: Adult; Aorta, Thoracic; Female; Humans; Male; Sex Characteristics; Thoracic Vertebrae; Tomography, X-Ray Computed
PubMed: 33884593
DOI: 10.14744/tjtes.2020.16794 -
Journal of Vascular Surgery Apr 2009We developed a novel method using anatomic markers along the thoracic aorta to accurately quantify longitudinal and circumferential cyclic strain in nondiseased thoracic... (Comparative Study)
Comparative Study
OBJECTIVE
We developed a novel method using anatomic markers along the thoracic aorta to accurately quantify longitudinal and circumferential cyclic strain in nondiseased thoracic aortas during the cardiac cycle and to compute age-related changes of the human thoracic aorta.
METHODS
Changes in thoracic aorta cyclic strains were quantified using cardiac-gated computed tomography image data of 14 patients (aged 35 to 80 years) with no visible aortic pathology (aneurysms or dissection). We measured the diameter and circumferential cyclic strain in the arch and descending thoracic aorta (DTA), the longitudinal cyclic strain along the DTA, and changes in arch length and motion of the ascending aorta relative to the DTA. Diameters were computed distal to the left coronary artery, proximal and distal to the brachiocephalic trunk, and distal to the left common carotid, left subclavian, and the first and seventh intercostal arteries. Cyclic strains were computed using the Green-Lagrange strain tensor. Arch length was defined along the vessel centerline from the left coronary artery to the first intercostal artery. The length of the DTA was defined along the vessel centerline from the first to seventh intercostal artery. Longitudinal cyclic strain was quantified as the difference between the systolic and diastolic DTA lengths divided by the diastolic DTA length. Comparisons were made between seven younger (age, 41 +/- 7 years; 5 men) and seven older (age, 68 +/- 6 years; 5 men) patients.
RESULTS
The average increase of diameters of the thoracic aorta was 14% with age from the younger to the older (mean age, 41 vs 68 years) group. The average circumferential cyclic strain of the thoracic aorta decreased by 55% with age from the younger to the older group. The longitudinal cyclic strain decreased with age by 50% from the younger to older group (2.0% +/- 0.4% vs 1.0% +/- 1%, P = .03). The arch length increased by 14% with age from the younger to the older group (134 +/- 17 mm vs 152 +/- 10 mm, P = .03).
CONCLUSIONS
The thoracic aorta enlarges circumferentially and axially and deforms significantly less in the circumferential and longitudinal directions with increasing age. To our knowledge, this is the first quantitative description of in vivo longitudinal cyclic strain and length changes for the human thoracic aorta, creating a foundation for standards in reporting data related to in vivo deformation and may have significant implications in endoaortic device design, testing, and stability.
Topics: Adult; Age Factors; Aged; Aged, 80 and over; Aging; Aorta, Thoracic; Aortography; Elasticity; Electrocardiography; Female; Humans; Male; Middle Aged; Pulsatile Flow; Radiographic Image Interpretation, Computer-Assisted; Retrospective Studies; Stress, Mechanical; Tomography, X-Ray Computed
PubMed: 19341890
DOI: 10.1016/j.jvs.2008.11.056 -
Journal of the Royal Society, Interface Dec 2018Accumulated glycosaminoglycans (GAGs) can sequester water and induce swelling within the intra-lamellar spaces of the medial layer of an artery. It is increasingly...
Accumulated glycosaminoglycans (GAGs) can sequester water and induce swelling within the intra-lamellar spaces of the medial layer of an artery. It is increasingly believed that stress concentrations caused by focal swelling can trigger the damage and delamination that is often seen in thoracic aortic disease. Here, we present computational simulations using an extended smoothed particle hydrodynamics approach to examine potential roles of pooled GAGs in initiating and propagating intra-lamellar delaminations. Using baseline models of the murine descending thoracic aorta, we first calculate stress distributions in a healthy vessel. Next, we examine increases in mechanical stress in regions surrounding GAG pools. The simulations show that smooth muscle activation can partially protect the wall from swelling-associated damage, consistent with experimental observations, but the wall can yet delaminate particularly in cases of smooth muscle dysfunction or absence. Moreover, pools of GAGs located at different but nearby locations can extend and coalesce, thus propagating a delamination. These findings, combined with a sensitivity study on the input parameters of the model, suggest that localized swelling can alter aortic mechanics in ways that eventually can cause catastrophic damage within the wall. There is, therefore, an increased need to consider roles of GAGs in aortic pathology.
Topics: Animals; Aorta, Thoracic; Computer Simulation; Glycosaminoglycans; Mice; Models, Cardiovascular; Vascular Diseases
PubMed: 30958237
DOI: 10.1098/rsif.2018.0616 -
Journal of Vascular Research 2018Central artery stiffening is recognized as a cardiovascular risk. The effects of hypertension and aging have been shown in human and animal models but the effect of salt... (Comparative Study)
Comparative Study
Central artery stiffening is recognized as a cardiovascular risk. The effects of hypertension and aging have been shown in human and animal models but the effect of salt is still controversial. We studied the effect of a high-salt diet on aortic stiffness in salt-sensitive spontaneously hypersensitive stroke-prone rats (SHRSP). Distensibility, distension, and β-stiffness were measured at thoracic and abdominal aortic sites in the same rats, using echotracking recording of the aortic diameter coupled with blood pressure (BP), in SHRSP-salt (5% salted diet, 5 weeks), SHRSP, and normotensive Wistar-Kyoto (WKY) rats. Hemodynamic parameters were measured at BP matched to that of WKY. Histological staining and immunohistochemistry were used for structural analysis. Hemodynamic isobaric parameters in SHRSP did not differ from WKY and only those from the abdominal aorta of SHRSP-salt presented decreased distensibility and increased stiffness compared with WKY and SHRSP. The abdominal and thoracic aortas presented similar thickening, increased fibrosis, and remodeling with no change in collagen content. SHRSP-salt presented a specific increased elastin disarray at the abdominal aorta level but a decrease in elastin content in the thoracic aorta. This study demonstrates the pro-stiffening effect of salt in addition to hypertension; it shows that only the abdominal aorta presents a specific pressure-independent stiffening, in which elastin disarray is likely a key mechanism.
Topics: Animals; Aorta, Abdominal; Aorta, Thoracic; Arterial Pressure; Disease Models, Animal; Elastin; Fibrosis; Hypertension; Male; Rats, Inbred SHR; Rats, Inbred WKY; Sodium Chloride, Dietary; Vascular Remodeling; Vascular Stiffness
PubMed: 29886482
DOI: 10.1159/000488877