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European Journal of Vascular and... Jan 2017
Topics: Aorta, Thoracic; Aortic Diseases; Endovascular Procedures; Humans; Postoperative Complications
PubMed: 28081802
DOI: 10.1016/j.ejvs.2016.06.005 -
JACC. Cardiovascular Imaging Jun 2018In diagnosing and following patients with acute aortic syndromes and thoracic aortic aneurysms, high-quality imaging of the thoracic aorta is indispensable. Mainstay... (Review)
Review
In diagnosing and following patients with acute aortic syndromes and thoracic aortic aneurysms, high-quality imaging of the thoracic aorta is indispensable. Mainstay modalities for thoracic aortic imaging are echocardiography, computed tomographic angiography, and magnetic resonance angiography. For any given clinical scenario, the imaging modality and protocol chosen will have a significant impact on sensitivity and specificity for the aortic diagnosis of concern. Imaging can also provide important ancillary information regarding myocardial performance, aortic valve morphology and function, and end-organ perfusion. Surveillance of patients following thoracic aortic surgery with serial imaging studies can identify complications that may require reintervention, and imaging has played an integral role in development of new surgical and interventional methods. Emerging techniques in thoracic aortic imaging include positron emission tomography, which addresses vessel wall inflammation, and 4-dimensional magnetic resonance angiography, which illustrates flow dynamics.
Topics: Aorta, Thoracic; Aortic Diseases; Hemodynamics; Humans; Multimodal Imaging; Predictive Value of Tests; Prognosis; Regional Blood Flow
PubMed: 29880113
DOI: 10.1016/j.jcmg.2018.03.009 -
Seminars in Vascular Surgery Jun 2023The most important descending thoracic aortic (DTA) pathologies are aneurysms, dissections, and traumatic injuries. In acute settings, these conditions can constitute a... (Review)
Review
The most important descending thoracic aortic (DTA) pathologies are aneurysms, dissections, and traumatic injuries. In acute settings, these conditions can constitute a significant risk of bleeding or ischemia of vital organs, resulting in a fatal outcome. Morbidity and mortality associated with aortic pathologies remain significant, despite improvements in medical therapy and endovascular techniques. In this narrative review, we present an overview of the transitions in the management of these pathologies and discuss current challenges and future perspectives. Diagnostic challenges include differentiating between thoracic aortic pathologies and cardiac diseases. Efforts have been made to identify a blood test that can rapidly differentiate these pathologies. Computed tomography is the cornerstone of diagnosing thoracic aortic emergencies. Our understanding of DTA pathologies has improved substantially due to the significant advancement in imaging modalities in the last 2 decades. On the basis of this understanding, the treatment of these pathologies has been revolutionized. Unfortunately, robust evidence from prospective and randomized studies is still lacking for the management of most DTA diseases. Medical management plays a crucial role in achieving early stability during these life-threatening emergencies. This includes intensive care monitoring, heart rate and blood pressure control, and considering permissive hypotension for patients presenting with ruptured aneurysms. Over the years, surgical management of DTA pathologies changed from open repair to endovascular repair with dedicated stent-grafts. Techniques in both spectrums have improved substantially.
Topics: Humans; Blood Vessel Prosthesis; Aortic Aneurysm, Thoracic; Blood Vessel Prosthesis Implantation; Stents; Emergencies; Prospective Studies; Endovascular Procedures; Treatment Outcome; Aorta, Thoracic
PubMed: 37330228
DOI: 10.1053/j.semvascsurg.2023.04.009 -
Presse Medicale (Paris, France : 1983) Feb 2018Degenerative aneurysms of the thoracic aorta are increasing in prevalence. The recognition of the decreased morbidity of this approach compared with open repair was... (Review)
Review
Degenerative aneurysms of the thoracic aorta are increasing in prevalence. The recognition of the decreased morbidity of this approach compared with open repair was readily apparent, as it avoided left thoracotomy, aortic cross-clamping, and left heart bypass. Repair of isolated descending thoracic aortic aneurysms using stent grafts was introduced in 1995, and in an anatomically suitable subgroup of patients with thoracic aortic aneurysm, repair with endovascular stent graft provides favorable outcomes, with decreased perioperative morbidity and mortality relative to open repair. The cornerstones of successful thoracic endovascular aneurysm repair are appropriate patient selection, thorough preprocedural planning, and cautious procedural execution. Since then, TEVAR is increasingly being used for other aortic pathologies such as complicated type B dissection, traumatic aortic transection, and aneurysmal disease extending into the arch or visceral segment, requiring debranching procedures.
Topics: Aortic Dissection; Aorta, Thoracic; Aortic Aneurysm, Thoracic; Computed Tomography Angiography; Endovascular Procedures; Humans; Magnetic Resonance Angiography; Prosthesis Implantation
PubMed: 29482890
DOI: 10.1016/j.lpm.2017.12.004 -
Scientific Reports Jul 2021The aim was to evaluate the thoracic aorta in different cardiac phases to obtain the correct cardiac phase for measuring the maximum diameter required to predict aortic...
The aim was to evaluate the thoracic aorta in different cardiac phases to obtain the correct cardiac phase for measuring the maximum diameter required to predict aortic disease. Cardiac CT was performed on 97 patients for suspected coronary artery disease. The average diameter of ascending (AAD) and descending aorta (DAD) in the plane of pulmonary bifurcation, in the plane of the sinus junction (AAD [STJ] and DAD [STJ]), descending aorta in the plane of the diaphragm (DAD [Dia]), the diameter of the main pulmonary artery (MPAD), distance from the sternum to the spine (S-SD), and distance from the sternum to the ascending aorta (S-AAD) were assessed at 20 different time points in the cardiac cycle. Differences in aortic diameter in different cardiac phases and the correlation between aortic diameter and traditional risk factors were analyzed by the general linear mixed model. The diameter of the thoracic aorta reached the minimum at the phase of 95-0%, and reached the maximum at 30-35%. The maximum values of AAD, AAD (STJ), DAD, DAD (STJ), and DAD (Dia) were 32.51 ± 3.35 mm, 28.86 ± 3.01 mm, 23.46 ± 2.88 mm, 21.85 ± 2.58 mm, and 21.09 ± 2.66 mm, respectively. The maximum values of MPAD/AAD and DAD/AAD (STJ) were 0.8140 ± 0.1029, 0.7623 ± 0.0799, respectively. The diameter of the thoracic aorta varies with the cardiac phase. Analyzing the changes in aortic diameter, which can be done using cardiac CT, could provide a more accurate clinical measurement for predicting aortic disease.
Topics: Adult; Aorta, Thoracic; Cardiac Imaging Techniques; Cross-Sectional Studies; Female; Humans; Male; Middle Aged; Tomography, X-Ray Computed
PubMed: 34312448
DOI: 10.1038/s41598-021-94677-5 -
Pediatric Radiology Jun 2010Although anomalies of the aortic arch and its branches are relatively uncommon malformations, they are often associated with congenital heart disease. Isolated lesions... (Review)
Review
Although anomalies of the aortic arch and its branches are relatively uncommon malformations, they are often associated with congenital heart disease. Isolated lesions may be clinically significant when the airways are compromised by a vascular ring. In this article, the development and imaging appearance of the aortic arch system and its various malformations are reviewed.
Topics: Aorta, Thoracic; Female; Heart Defects, Congenital; Humans; Infant, Newborn; Magnetic Resonance Imaging; Male; Tomography, X-Ray Computed
PubMed: 20354848
DOI: 10.1007/s00247-010-1607-9 -
Seminars in Vascular Surgery Jun 2023Thoracic aortic emergencies involving the aortic arch are potentially fatal conditions that require the entire surgical repertoire of conventional surgery, such as... (Review)
Review
Thoracic aortic emergencies involving the aortic arch are potentially fatal conditions that require the entire surgical repertoire of conventional surgery, such as complete aortic arch replacement using the frozen-elephant-trunk technique, through hybrid procedures, to full surgical endovascular options with conventional or delivered/fenestrated stent-grafts. An interdisciplinary aortic team should choose the optimal treatment of the pathologies of the aortic arch, considering the morphology of the entire aorta, from the root to beyond the bifurcation, as well as the clinical comorbidities. The treatment goal is a complication-free postoperative result and lasting freedom from aortic reinterventions. Irrespective of the selected therapy method, patients should then be connected to a specialized aortic outpatient clinic. The aim of this review was to provide an overview of pathophysiology and current treatment options in emergencies of the thoracic aorta, also involving the aortic arch. We wanted to summarize the preoperative considerations, intraoperative settings, and strategies, as well the postoperative follow-up.
Topics: Humans; Aorta, Thoracic; Blood Vessel Prosthesis; Emergencies; Blood Vessel Prosthesis Implantation; Aorta; Aortic Aneurysm, Thoracic; Treatment Outcome; Retrospective Studies; Stents
PubMed: 37330229
DOI: 10.1053/j.semvascsurg.2023.04.016 -
Journal of the Royal Society, Interface Jun 2013Aortic disease is a significant cause of death in developed countries. The most common forms of aortic disease are aneurysm, dissection, atherosclerotic occlusion and... (Review)
Review
Aortic disease is a significant cause of death in developed countries. The most common forms of aortic disease are aneurysm, dissection, atherosclerotic occlusion and ageing-induced stiffening. The microstructure of the aortic tissue has been studied with great interest, because alteration of the quantity and/or architecture of the connective fibres (elastin and collagen) within the aortic wall, which directly imparts elasticity and strength, can lead to the mechanical and functional changes associated with these conditions. This review article summarizes the state of the art with respect to characterization of connective fibre microstructure in the wall of the human aorta in ageing and disease, with emphasis on the ascending thoracic aorta and abdominal aorta where the most common forms of aortic disease tend to occur.
Topics: Aging; Aorta; Aorta, Abdominal; Aorta, Thoracic; Aortic Diseases; Collagen; Elasticity; Elastin; Humans; Models, Anatomic
PubMed: 23536538
DOI: 10.1098/rsif.2012.1004 -
Interactive Cardiovascular and Thoracic... Nov 2022
Topics: Humans; Aorta, Thoracic; Thorax
PubMed: 36394267
DOI: 10.1093/icvts/ivac270 -
European Journal of Vascular and... Apr 2019
Topics: Aorta, Abdominal; Aorta, Thoracic; Aortic Aneurysm, Thoracic; Blood Vessel Prosthesis Implantation; Humans; Treatment Outcome
PubMed: 30711382
DOI: 10.1016/j.ejvs.2019.01.004