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1.
Rev Port Cir Cardiotorac Vasc ; 26(2): 131-137, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31476814

RESUMO

BACKGROUND: Type B aortic dissection (TBAD) is associated with high morbidity and mortality. The DISSECT classification aims to reunite clinical and anatomical characteristics of interest to clinicians involved in its management. This paper aims to characterize a cohort of patients admitted for type B aortic dissection in a tertiary institution. METHODS: This is a retrospective study that included all patients admitted to the hospital due to TBAD from 2006 to 2016. The computerized tomographic angiography that enabled the TBAD diagnosis were reevaluated using DISSECT classification. RESULTS: Thirty-two patients were included in this case series. As to DISSECT classification, 79.3% were acute (Duration), 66% had a primary Intimal tear location in aortic arch, the maximum aortic diameter was 44±13mm (Size), 60% extended from aortic arch to abdomen or iliac arteries (Segmental Extent), 28% presented with Complications, and 28% had partial Thrombosis of false lumen. Six patients underwent intervention during the follow-up period. At 12 months, overall survival was 75.4%±8.3% and survival free of aorta-related mortality was 87.0±6.1%. Survival free of aortic dilatation was 82.6±9.5%. In univariate analysis, the presence of complications and chronic kidney disease associated with increased overall and aorta-related mortality rates. Hypertension was associated with aortic dilatation. CONCLUSIONS: The outcomes after TBAD in a Portuguese center are reported. All interventions in TBAD were performed due to complications. The presence of complications and chronic kidney disease was associated with overall mortality and aorta-related mortality and hypertension with aortic dilatation. DISSECT classification was possible to apply in all patients.


Assuntos
Aneurisma Dissecante , Aneurisma da Aorta Torácica , Aneurisma Dissecante/classificação , Aneurisma Dissecante/diagnóstico por imagem , Aneurisma Dissecante/mortalidade , Aneurisma Dissecante/terapia , Aneurisma da Aorta Torácica/classificação , Aneurisma da Aorta Torácica/diagnóstico por imagem , Aneurisma da Aorta Torácica/mortalidade , Aneurisma da Aorta Torácica/terapia , Angiografia por Tomografia Computadorizada , Humanos , Estudos Retrospectivos , Resultado do Tratamento
2.
Medicine (Baltimore) ; 98(32): e16462, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31393350

RESUMO

The outcome of patients with acute type B aortic dissection (BAAD) is largely dictated by whether or not the case is "complicated." The purpose of this study was to investigate the risk factors leading to in-hospital death among patients with BAAD and then to develop a predictive model to estimate individual risk of in-hospital death.A total of 188 patients with BAAD were enrolled. Risk factors for in-hospital death were investigated with univariate and multivariable logistic regression analysis. Significant risk factors were used to develop a predictive model.The in-hospital mortality rate was 9% (17 of 188 patients). Univariate analysis revealed 7 risk factors to be statistically significant predictors of in-hospital death (P < .1). In multivariable analysis, the following variables at admission were independently associated with increased in-hospital mortality: hypotension (odds ratio [OR], 4.85; 95% confidence interval [CI], 1.12-18.90; P = .04), ischemic complications (OR, 8.24; 95% CI, 1.25-33.85; P < .001), renal dysfunction (OR, 12.32; 95% CI, 10.63-76.66; P < .001), and neutrophil percentage ≥80% (OR, 5.76; 95% CI, 2.58-12.56; P = .03). Based on these multivariable results, a reliable and simple prediction model was developed, a total score of 4 offered the best point value.Independent risk factors associated with in-hospital death can be predicted in BAAD patients. The prediction model could be used to identify the prognosis for BAAD patients and assist physicians in their choice of management.


Assuntos
Aneurisma Dissecante/mortalidade , Aneurisma da Aorta Torácica/mortalidade , Mortalidade Hospitalar , Adulto , Idoso , Aneurisma Dissecante/classificação , Aneurisma Dissecante/terapia , Aneurisma da Aorta Torácica/classificação , Aneurisma da Aorta Torácica/terapia , Comorbidade , Feminino , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Neutrófilos/metabolismo , Razão de Chances , Fatores de Risco
3.
BMJ Case Rep ; 12(7)2019 Jul 08.
Artigo em Inglês | MEDLINE | ID: mdl-31289149

RESUMO

Acute aortic dissection presenting neurological symptoms is rare and entails significant diagnostic challenges. We present a case of 45-year-old woman with a medical history of essential hypertension and smoking, admitted with lobar pneumonia. During her inpatient treatment, she developed severe back pain and numbness below the level of the umbilicus. Due to her presenting symptoms considered differential diagnoses were paravertebral abscess and acute stroke. CT scan of the head did not reveal any ischaemic changes. Further investigation with MRI (with and without contrast) raised concerns for possible aortic dissection. CT angiography of thorax, abdomen and pelvis displayed extensive aortic dissection extending from aortic root to left iliac artery limiting flow to right carotid artery causing stenosis. The patient was diagnosed with Stanford type A aortic dissection. The patient was referred to the cardiothoracic surgery team for surgical repair. The patient made a good recovery after a prolonged course of hospitalisation, followed by cardiac rehabilitation and physical therapy.


Assuntos
Aneurisma Dissecante/complicações , Aneurisma Dissecante/cirurgia , Paraplegia/etiologia , Doença Aguda , Aneurisma Dissecante/classificação , Aneurisma Dissecante/patologia , Aorta/diagnóstico por imagem , Aorta/patologia , Artérias Carótidas/patologia , Angiografia por Tomografia Computadorizada/métodos , Constrição Patológica , Diagnóstico Diferencial , Feminino , Humanos , Artéria Ilíaca/diagnóstico por imagem , Artéria Ilíaca/patologia , Imagem por Ressonância Magnética , Pessoa de Meia-Idade , Paraplegia/fisiopatologia , Resultado do Tratamento
4.
Med Sci Monit ; 25: 4933-4940, 2019 Jul 03.
Artigo em Inglês | MEDLINE | ID: mdl-31269009

RESUMO

BACKGROUND We discuss the presentation and management of extracranial carotid artery aneurysms (ECAAs) and to develop a new type of classification. MATERIAL AND METHODS A retrospective review of 35 ECAAs patients who were admitted in our institution from January 2010 to June 2016 was conducted. The mean follow-up period was 25.58±22.13 months. RESULTS During the study period, 35 aneurysms were diagnosed and treated (mean age, 50.8±15.6 years; 15 men). There were 28 true aneurysms, 5 false aneurysms, and 2 dissecting aneurysms. A total of 16 patients with true aneurysms underwent open surgical treatment (group 1), whereas 15 received endovascular management, including all false and dissecting aneurysms (group 2). The remaining 4 true aneurysms were treated with hybrid operation (group 3). The patency rates of groups 1, 2, and 3 were 100%, 93.3%, and 100%, respectively. According to the Peking Union Medical College Hospital (PUMCH) Classification, all 24 cases of type Ia aneurysms were treated by either open surgery and/or endovascular treatment, whereas all 3 type Ib cases were treated solely by open surgery. All 5 type IIa patients were treated by endovascular treatment, with the exception of 1 failure that was transferred to hybrid operation. All 3 type IIb patients were treated by hybrid operation. CONCLUSIONS Open surgery was more frequently feasible in true aneurysms, and endovascular surgery was the first choice for false and dissecting aneurysms. Hybrid operation was available for complicated cases. The PUMCH classification may be helpful for selection of management strategies for ECAAs.


Assuntos
Aneurisma Dissecante/cirurgia , Artérias Carótidas/cirurgia , Procedimentos Endovasculares/métodos , Adulto , Idoso , Aneurisma Dissecante/classificação , Aneurisma Dissecante/fisiopatologia , Implante de Prótese Vascular/efeitos adversos , Artérias Carótidas/fisiopatologia , Doenças das Artérias Carótidas/cirurgia , China , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento
5.
Medicine (Baltimore) ; 98(14): e14857, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30946313

RESUMO

Vertebrobasilar artery dissecting aneurysm (VBA-DA) is associated with serious complications and poor prognosis in patients. High-resolution magnetic resonance imaging (HR-MRI) is a noninvasive method for the diagnosis of VBA-DA.VBA-DAs were classified according to the feature of HR-MRI in combination with digital subtraction angiography (DSA), and the clinical outcomes of different types of VBA-DAs were analyzed. Thirty-nine patients with 42 VBA-DAs were included and underwent HR-MRI, including three-dimensional T1 weighted image, three-dimensional T2 weighted image (3D-T2WI), three-dimensional time of flight MRA (3D-TOF-MRA), and three-dimensional fast imaging employing steady state acquisition (3D-FIESTA), and hematoma and flaps were compared. The follow-up was 3 to 25 months. The VBA-DAs were classified based on the images of HR-MRI and DSA, and the prognosis was analyzed.VBA-DAs more frequently occurred on the vertebral artery, especially on the dominant vertebral artery. 3D-TOF-MRA showed high signal from hematoma, and 3D-FIESTA showed high signal from flaps. Based on HR-MRI images in combination with DSA, VBA-DAs were classified into 4 types: classical, stenosis, spiral, and hemorrhagic. The patients with the classical VBA-DAs had a higher improvement rate and a lower exacerbation rate. The patients with spiral and hemorrhagic VBA-DAs had poor clinical outcomes. The patients with stenosis VBA-DAs had poorer clinical outcomes than classical types and better clinical outcomes than spiral and hemorrhagic types.The detection of intramural hematoma and dissection flap using HR-MRI provides basic information for the diagnosis of VBA-DA. Individualized therapeutic strategies can be designed for the treatment of VBA-DAs with different features of DSA and HR-MRI.


Assuntos
Aneurisma Dissecante/diagnóstico por imagem , Angiografia Digital/métodos , Artéria Basilar/diagnóstico por imagem , Imagem por Ressonância Magnética/métodos , Artéria Vertebral/diagnóstico por imagem , Idoso , Aneurisma Dissecante/classificação , Aneurisma Dissecante/patologia , Artéria Basilar/patologia , Feminino , Seguimentos , Hematoma/diagnóstico por imagem , Hematoma/patologia , Humanos , Imageamento Tridimensional/métodos , Masculino , Pessoa de Meia-Idade , Prognóstico , Artéria Vertebral/patologia
6.
Cardiovasc Interv Ther ; 34(4): 317-324, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30652250

RESUMO

The mechanism of how angiographic results following paclitaxel-coated balloon (PCB) treatment for small vessel disease affect patient outcome remains unknown. In the present study, we aimed to investigate the correlation between coronary dissection immediately after PCB angioplasty and midterm outcome. From March 2014 to March 2017, 171 consecutive patients with 228 native coronary artery lesions who received PCB angioplasty at a single center were enrolled retrospectively. Lesions with a reference vessel diameter > 2.8 mm were excluded. There were dissections in 80% of the lesions immediately following PCB angioplasty. Of these, 38% were type A, 29% were type B, and 13% were type C or more severe dissection. No patient required revascularization during hospitalization. We were able to follow 159 patients (212 lesions) clinically for > 6 months, from among whom target lesion revascularization (TLR) was performed in 7% of the patients. Follow-up angiography was performed on 143 lesions (67%), and complete healing of all dissections was noted. The rates of restenosis and late lumen enlargement were 12% and 56%, respectively. Multivariate analysis identified that a bending lesion was an independent predictor of TLR, and type C-E dissection and imaging device use were independent predictors of restenosis. Conversely, lesions with type B dissection had a larger net gain than lesions with type A or no dissection. Leaving the dissection uncovered after PCB angioplasty seems to be safe, resulting in a low acute event rate. The type B dissection after PCB angioplasty was the most therapeutic dissection.


Assuntos
Aneurisma Dissecante/diagnóstico por imagem , Angioplastia Coronária com Balão , Aneurisma Coronário/diagnóstico por imagem , Angiografia Coronária , Doença da Artéria Coronariana/terapia , Idoso , Aneurisma Dissecante/classificação , Materiais Revestidos Biocompatíveis , Aneurisma Coronário/classificação , Reestenose Coronária/diagnóstico por imagem , Feminino , Humanos , Masculino , Paclitaxel/administração & dosagem , Estudos Retrospectivos
7.
J Cardiovasc Surg (Torino) ; 60(4): 496-500, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-27145124

RESUMO

INTRODUCTION: Aortic dissections classification systems have always been an argument of debate. It is well known that none of the described classifications is complete and easy at the same time. While the more used classification is currently the Stanford classification, it is clear that type A and B dissections prognosis can dramatically vary, depending on many different characteristics that they can present. The aim of this study was to propose a new severity score system that could reflect the risk of in hospital mortality of acute aortic dissections. EVIDENCE ACQUISITION: Through a review of the literature, studies describing significant predictors of in hospital mortality of any type of aortic dissection were searched and selected by predefined selection criteria. EVIDENCE SYNTHESIS: Nine studies met the criteria and were finally analyzed. The Odds Ratios of the reported predictors were the basis to the drawing of the score system. Sixteen main in hospital mortality predictors were found, 14 of which described in more than one study. They were combined into a new severity score system that we named VI2TA2 S2C2ORE. CONCLUSIONS: This is a simple risk score that we propose as a first assessment risk-evaluating tool. We look forward to validate it and to describe specific in hospital mortality risk ranges once it will be adopted.


Assuntos
Aneurisma Dissecante/classificação , Aneurisma Dissecante/mortalidade , Aneurisma Aórtico/classificação , Mortalidade Hospitalar , Doença Aguda , Aneurisma Aórtico/mortalidade , Hospitalização , Humanos , Razão de Chances , Prognóstico , Fatores de Risco , Índice de Gravidade de Doença
8.
J Vasc Surg ; 70(1): 53-59, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30591296

RESUMO

OBJECTIVE: To describe index visits for acute aortic dissection (AD) to an academic center and validate the prevailing claims-based methodology to identify and stratify them. METHODS: Inpatient hospitalizations at a single center assigned an International Classification of Diseases, Ninth Revision (ICD-9) diagnosis code for AD from January 2005 to September 2015 were identified. Diagnoses were verified by review of medical records and imaging studies. All visits were secondarily stratified with the algorithm based on ICD-9 codes. Sensitivity and specificity analyses were conducted to evaluate the ability of the algorithm to correctly identify acute AD by Stanford class and treatment modality (type A open repair [TAOR], type B open repair [TBOR], thoracic endovascular repair [TEVAR], medical management [MM]). RESULTS: In the study interval, there were 1245 visits coded for AD attributed to 968 unique patients. Chart review verification demonstrated that the majority of visits were for AD (79%; n = 981), of which 32% (n = 310) were for an index acute AD event. The true distribution of acute AD visit classifications was TAOR (46.1%; n = 143), TBOR (5.2%; n = 16), TEVAR (7.7%; n = 24), and MM (39.4%; n = 122). The algorithm, which used ICD-9 codes, identified 631 acute visits and stratified them as TAOR (27.1%; n = 171), TBOR (4.1%; n = 26), TEVAR (4.9%; n = 31), and MM (63.9%; n = 403). Analyses demonstrated high specificities, but generally low sensitivities of the algorithm (TAOR: sensitivity, 58%, specificity, 92%; TBOR: sensitivity, 13%, specificity, 98%; TEVAR: sensitivity, 17%, specificity, 98%; MM: sensitivity, 73%, specificity, 72%). CONCLUSIONS: The prevalent claims-based strategy to identify hospitalizations with acute AD is specific, but lacks sensitivity. Caution should be exercised when studying AD with ICD-9 codes and improvements to existing claims-based methodologies are necessary to support future study of acute AD.


Assuntos
Demandas Administrativas em Assistência à Saúde , Algoritmos , Aneurisma Dissecante/terapia , Aneurisma da Aorta Abdominal/terapia , Aneurisma da Aorta Torácica/terapia , Implante de Prótese Vascular , Fármacos Cardiovasculares/uso terapêutico , Mineração de Dados/métodos , Procedimentos Endovasculares , Classificação Internacional de Doenças , Admissão do Paciente , Idoso , Aneurisma Dissecante/classificação , Aneurisma Dissecante/diagnóstico , Aneurisma da Aorta Abdominal/classificação , Aneurisma da Aorta Abdominal/diagnóstico , Aneurisma da Aorta Torácica/classificação , Aneurisma da Aorta Torácica/diagnóstico , Implante de Prótese Vascular/classificação , Fármacos Cardiovasculares/classificação , Bases de Dados Factuais , Procedimentos Endovasculares/classificação , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , Estudos Retrospectivos
9.
Medicine (Baltimore) ; 97(50): e13699, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30558083

RESUMO

RATIONALE: Acute type A aortic dissection (AAAD) remains a life-threatening disease. We previously reported a case with ultrasound findings of a homogeneous hemopericardium and evidence highly indicative of hemorrhagic cardiac tamponade complicated by AAAD. Here, we report a similar case who presented with a more serious situation and for whom critical care ultrasound revealed fast blood clot formation within the hemopericardium. PRESENTING CONCERNS: A 63-year-old man was admitted to our emergency department with a complaint of a tearing chest pain for 10 minutes. Asymmetric blood pressure was detected in the upper limbs and AAAD was highly suspected. An electrocardiogram (ECG) monitor was placed in a timely manner. However, during this procedure, he went into cardiac arrest and cardiopulmonary resuscitation (CPR) was initiated. DIAGNOSES: Critical care ultrasound revealed hemorrhagic cardiac tamponade with blood clot formation surrounding the epicardium, strongly indicating the rupture of an ascending aortic root dissection. INTERVENTIONS: Standard CPR continued for 30 minutes. OUTCOMES: Spontaneous cardiac rhythm was not restored and the patient died. LESSONS: Critical care ultrasound is a useful tool for assessing emergency cardiac arrest. Ultrasound findings of fast clot formation within the hemopericardium may indicate faster bleeding due to the rupture of an AAAD and may predict poor clinical outcomes.


Assuntos
Aneurisma Dissecante/complicações , Tamponamento Cardíaco/etiologia , Hemorragia/patologia , Trombose/diagnóstico por imagem , Aneurisma Dissecante/classificação , Aneurisma Dissecante/diagnóstico por imagem , Aneurisma Dissecante/patologia , Reanimação Cardiopulmonar/métodos , Dor no Peito/diagnóstico , Evolução Fatal , Hemorragia/complicações , Humanos , Masculino , Pessoa de Meia-Idade , Derrame Pericárdico/etiologia , Trombose/complicações , Ultrassonografia/métodos
10.
Radiographics ; 38(7): 1949-1972, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30312138

RESUMO

Treatment of thoracic aortic dissection remains highly challenging and is rapidly evolving. Common classifications of thoracic aortic dissection include the Stanford classification (types A and B) and the DeBakey classification (types I to III), as well as a new supplementary classification geared toward endovascular decision making. By using various imaging techniques, the extent of the dissection, the location of the primary intimal tear, the shape of the aortic arch, and the zonal involvement of the aortic arch-factors that affect the treatment strategy-can easily be identified. Thoracic endovascular aortic repair (TEVAR) is generally performed in two groups of patients: (a) those with a surgically repaired type A dissection, and (b) those with a complicated type B dissection. Several imaging findings can help predict the course of remodeling of the dissected aorta after a repaired type A dissection and TEVAR. A spectrum of imaging findings exist with regard to favorable (positive) or failing (negative) remodeling. A schematic model with imaging support allows the classification of important causes of failing remodeling into proximal and distal groups, on the basis of the origin of the refilling of the false lumen and the underlying pathophysiology of pressurization. Refilling of the false lumen of the aorta after repair of a type A dissection is usually secondary to a persistent intimal tear at the aortic arch, a leak of the distal graft anastomosis, or refilling from the false lumen of a dissected aortic arch vessel. After TEVAR, false lumen refilling is most commonly due to an incomplete seal of the proximal landing related to the aortic tortuosity, an arch branch stump, a supra-arch chimney stent, or the TEVAR technique. Online supplemental material is available for this article. ©RSNA, 2018.


Assuntos
Aneurisma Dissecante/diagnóstico por imagem , Aneurisma Dissecante/cirurgia , Aneurisma da Aorta Torácica/diagnóstico por imagem , Aneurisma da Aorta Torácica/cirurgia , Procedimentos Endovasculares , Aneurisma Dissecante/classificação , Aneurisma da Aorta Torácica/classificação , Humanos , Resultado do Tratamento
11.
Eur J Vasc Endovasc Surg ; 56(6): 911-917, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30241982

RESUMO

OBJECTIVES: To examine the correlation between computed tomography (CT) features and clinical presentation and to assess the management strategy for patients with isolated superior mesenteric artery (SMA) dissection. MATERIAL AND METHODS: Retrospective analysis of clinical records and CT findings of patients with isolated superior mesenteric artery dissection treated between 2012 and 2016. The relationship between CT features and clinical symptoms and treatment options was studied. Follow up CT images were reviewed and telephone interviews were conducted with patients. RESULTS: Sixty-nine patients with isolated SMA dissection (47 symptomatic and 22 asymptomatic) were evaluated. The dissection length in patients with Sakamoto type IV lesions was significantly longer than that in patients with other lesion types (83.0 ± 40.1 mm, p = .001). Compared with the asymptomatic group, the symptomatic group had longer dissections (63.5 ± 35.9 mm, p < .001) and lesser true lumen diameter (3.1 ± 1.7 mm, p = .044). Fifty-six patients were treated conservatively, of whom 31 showed clinical improvement and exhibited no morphological change during long-term follow up. CONCLUSIONS: In patients with isolated SMA dissection, clinical symptoms were related to the length of dissection and degree of true lumen stenosis. Conservative treatment was commonly employed and yielded favourable outcomes.


Assuntos
Aneurisma Dissecante/diagnóstico por imagem , Aneurisma Dissecante/terapia , Artéria Mesentérica Superior/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Adulto , Idoso , Idoso de 80 Anos ou mais , Aneurisma Dissecante/classificação , Aneurisma Dissecante/cirurgia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
12.
J Cardiothorac Surg ; 13(1): 92, 2018 Sep 04.
Artigo em Inglês | MEDLINE | ID: mdl-30180871

RESUMO

BACKGROUND: It is well known that there are major differences between the Japanese and Western population regarding the incidence of ischemic heart disease and stroke. The purpose of this study was to evaluate differences of patients' characteristics between Belgian and Japanese cohort with acute type A aortic dissection. METHODS: In 487 patients (297 male patients, mean age 61.9 ± 12.2 yrs) who underwent surgery for acute type A aortic dissection, baseline preoperative and intraoperative data were collected. Belgian patients (n = 237) were compared to Japanese patients (n = 250). Clinical data included patient demographics, history, status at presentation, imaging study results and intraoperative findings. RESULTS: The Japanese cohort had significantly more women (48.8% vs. 28.7%, p < 0.0001), lower BMI (24.2 vs. 26.4, p < 0.0001) and lower prevalence of hypertension (49.2% vs. 65.8%, p = 0.0002). More DeBakey type I dissections and less type III dissections with retrograde extension were reported in Belgium than in Japan (77.2% vs. 48.4%, p < 0.0001, 3.4% vs. 38.7%, p < 0.0001, respectively). More entries were found in the ascending aorta (78.5% vs. 58.5%, p < 0.0001) and aortic arch (24.9% vs. 13.7%, p = 0.0018) in Belgian patients than in Japanese patients, who had more entries in the descending aorta or undetected entries. CONCLUSIONS: In acute type A aortic dissection, Belgian patients reveal striking differences from Japanese patients regarding gender distribution, entry tear location and type of dissection. Japanese women are more likely to develop acute type A aortic dissection than Belgian women. (234 words).


Assuntos
Aneurisma Dissecante/classificação , Aneurisma Dissecante/cirurgia , Aneurisma Aórtico/classificação , Aneurisma Aórtico/cirurgia , Doença Aguda , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Aneurisma Dissecante/complicações , Aorta/cirurgia , Aorta Torácica/cirurgia , Aneurisma Aórtico/complicações , Bélgica , Índice de Massa Corporal , Feminino , Humanos , Japão , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores Sexuais , Adulto Jovem
13.
Ann Thorac Surg ; 106(6): 1759-1766, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-29966590

RESUMO

BACKGROUND: Current stratification systems for patients presenting with acute type A aortic dissection rely on signs of malperfusion to predict mortality. The authors sought to develop an algorithm to readily risk stratify these patients using admission characteristics. METHODS: Two hundred sixty-nine consecutive patients who underwent type A repair between 2002 and 2015 were reviewed for easily obtainable preoperative demographics and laboratory values deemed a priori as potential predictors of operative mortality. Multiple logistic regression analysis was performed to determine independent significance, and linear regression was performed to generate the concomitant regression expression of the variables significant on bivariate analysis. RESULTS: Operative mortality was 16% (43/269) and was 29% (34/119) among patients who presented with malperfusion. Upon multivariate analysis, creatinine (p = 0.008), liver malperfusion (p = 0.006), and lactic acid level (p = 0.0007) remained independent significant predictors. Regression coefficients allowed the generation of a risk score as 5.5 × (lactic acid [mmol/L]) + 8 × (creatinine [mg/dL]) ± 8 (+ if liver malperfusion presents, - if no liver malperfusion). Upon receiver-operating characteristic curve analysis this model generated a c-statistic of 0.75. Operative mortality among patients within the lowest tertile (risk score < 7) was 4%, whereas patients in the middle (7 to 20) and highest (≥20) tertiles had mortality rates of 14% 37%, respectively. CONCLUSIONS: Although still requiring external validation, the innovative risk score presented necessitates knowledge of lactic acid, serum creatinine, and liver function tests. The algorithm predicts operative mortality with high accuracy and offers clinicians a novel tool to improve preoperative guidance and prognosis.


Assuntos
Aneurisma Dissecante/cirurgia , Doenças da Aorta/cirurgia , Complicações Pós-Operatórias/mortalidade , Doença Aguda , Adulto , Idoso , Idoso de 80 Anos ou mais , Aneurisma Dissecante/classificação , Doenças da Aorta/classificação , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Medição de Risco
14.
Am J Cardiol ; 122(4): 689-695, 2018 08 15.
Artigo em Inglês | MEDLINE | ID: mdl-29970240

RESUMO

The DeBakey classification divides type A acute aortic dissection (AAD) into type I and type II; the latter limited to the ascending aorta. We endeavored to examine differences in DeBakey groups in a contemporary registry. We divided 1,872 patients with noniatrogenic AAD from the International Registry of Acute Aortic Dissection into type I (n = 1691, 90.3%) and type II (n = 181, 9.7%). Patients with type II AAD were older. On presentation, patients with type I AAD reported more back and abdominal pain and were more likely to have pulse deficit. Intramural hematoma was more frequent in type II AAD. Most patients with both types were treated surgically. Lower rates of renal failure, coma, mesenteric and limb ischemia were noted in those with type II AAD. In-hospital death was less frequent (16.6% vs 22.5%) after type II AAD, a trend that did not reach significance. There was no difference in the incidence of new dissection, rapid aortic growth, late aortic intervention or survival at 5 years. In conclusion, AAD limited to the ascending aorta (DeBakey type II) appears to be associated with improved clinical outcomes compared with dissection that extend to the aortic arch or beyond. Although fewer dissection-related complications were noted in patients presenting with type II AAD, as was a trend toward reduced in-hospital mortality, 5-year survival and descending aortic sequelae are not reduced in this contemporary report from International Registry of Acute Aortic Dissection.


Assuntos
Aneurisma Dissecante/classificação , Aneurisma da Aorta Torácica/classificação , Implante de Prótese Vascular/métodos , Sistema de Registros , Stents , Doença Aguda , Idoso , Aneurisma Dissecante/mortalidade , Aneurisma Dissecante/cirurgia , Aneurisma da Aorta Torácica/mortalidade , Aneurisma da Aorta Torácica/cirurgia , Canadá/epidemiologia , Europa (Continente)/epidemiologia , Feminino , Seguimentos , Mortalidade Hospitalar/tendências , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Taxa de Sobrevida/tendências , Fatores de Tempo , Resultado do Tratamento , Estados Unidos/epidemiologia
15.
Rev Med Liege ; 73(5-6): 290-295, 2018 May.
Artigo em Francês | MEDLINE | ID: mdl-29926568

RESUMO

Aortic dissection is a life-threatening condition due to a tear in the intimal layer of the aorta or bleeding within the aortic wall, resulting in the separation of the different layers of the aortic wall. Among the risk factors, age, hypertension, dyslipidemia and genetic disorders of the connective tissue have been identified. A prompt diagnosis and an adequate treatment are important in the management of affected patients. The type of treatment depends on the location and extension of the dissection. Open surgical repair is most commonly used for dissections involving the ascending aorta and the aortic arch, whereas endovascular intervention is indicated for descending aorta dissections that are complicated. In this paper, we will review the epidemiology, and physiopathology of aortic dissection and describe the appropriate management for each type of dissection (open surgery, endovascular or medical treatment).


Assuntos
Aneurisma Dissecante , Aneurisma Dissecante/classificação , Aneurisma Dissecante/diagnóstico , Aneurisma Dissecante/epidemiologia , Aneurisma Dissecante/terapia , Procedimentos Cirúrgicos Cardíacos/métodos , Procedimentos Endovasculares , Humanos , Fatores de Risco
16.
J Invasive Cardiol ; 30(4): 145-146, 2018 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-29610445

RESUMO

Dissections following interventions in the infrainguinal arteries occur very frequently and are mostly under-appreciated on angiographic imaging. Media and external elastic lamina injury can contribute to loss of patency, and intravascular ultrasound (IVUS) can identify this type of injury. The circumference of injury also has been proposed to be a predictor of outcome. We therefore propose a classification combining depth of injury from intima to adventitia with circumference of dissection. This classification exhibits six dissection grades (A1, A2, B1, B2, C1, and C2) as seen on IVUS (the "iDissection" classification).


Assuntos
Aneurisma Dissecante , Cateterismo Periférico/efeitos adversos , Artéria Femoral , Artéria Poplítea , Ultrassonografia de Intervenção/métodos , Lesões do Sistema Vascular/complicações , Aneurisma Dissecante/classificação , Aneurisma Dissecante/diagnóstico , Aneurisma Dissecante/etiologia , Humanos , Lesões do Sistema Vascular/diagnóstico
17.
Abdom Radiol (NY) ; 43(11): 3157-3165, 2018 11.
Artigo em Inglês | MEDLINE | ID: mdl-29550960

RESUMO

PURPOSE: The purpose of the study is to propose a computed tomography (CT) classification of spontaneous isolated superior mesenteric artery dissection (SISMAD) correlated with clinical presentation METHODS: We retrospectively reviewed CT images of 40 patients with SISMAD at our institution from 2006 to 2015 and proposed a new classification: type I, patent false lumen with both entry and re-entry; type II, patent false lumen without re-entry; type III, completely or partially thrombosed false lumen; and type IV, thrombosed false lumen with ulcer-like projection. Additionally, we included a subtype (S) at each type when there was either a long segment of dissection and/or significant true lumen stenosis. CT features were statistically analyzed using Fisher's exact and Mann-Whitney test. RESULTS: The CT findings classified patients as type I (15%), type II (12.5%), type III (35%), and type IV (37.5%). Of the 40 patients, 25 (62.5%) were symptomatic. There was a significantly different proportion of each type between symptomatic and asymptomatic patients (p = 0.005). There were 25 patients with subtype (S); no type I or II, 12 type III, and 13 type IV. The symptomatic patients showed longer dissection tendency and more severe true lumen stenosis (78% vs. 53%, p = 0.000) compared with asymptomatic patients. CONCLUSION: The proposed multi-detector CT classification of SISMAD correlates with clinical presentation. This new classification could be helpful for treatment planning.


Assuntos
Aneurisma Dissecante/classificação , Aneurisma Dissecante/diagnóstico por imagem , Artéria Mesentérica Superior/diagnóstico por imagem , Tomografia Computadorizada Multidetectores/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Meios de Contraste , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
18.
Medicine (Baltimore) ; 97(5): e9705, 2018 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-29384849

RESUMO

We aimed to identify natural course and optimal management of spontaneous isolated celiac artery dissection (SICAD) according to morphologic classification determined on computed tomography angiography (CTA), and to investigate the association between symptoms and morphological classification of SICAD.This retrospective observational study included 21 consecutive patients with SICAD from January 2012 to April 2017. Demographic data, clinical features, treatment modalities, follow-up results, and CTA findings including morphologic classification, dissection length, and relative diameter of the true lumen (TLRD) were reviewed. Changes in follow-up CTA were recorded and compared to prior studies to reveal natural course of the disease.The serial changes of SICAD on follow-up CTA according to morphologic classifications were as follows; type I (5/5, no interval change), type IIa (1/1, no interval change), type IIb (1/1, partial remodeling), type IIIa (1/4, complete remodeling; 1/4, partial remodeling; 1/4, no interval change; 1/4, deterioration), type IIIb (4/6, no interval change; 2/6, partial remodeling), and type IV (2/2, no interval change). Thirteen (61.9%) symptomatic and 8 (38.1%) asymptomatic patients were all treated with conservative management with or without antiplatelet and/or anticoagulation therapies. Symptomatic group (SG) more commonly had type IIb, IIIa, IIIb, and IV than asymptomatic group (AG) (SG; 11 patients, AG; 1 patient, P = .002). TLRD in AG was larger than that in SG (SG: 40.5 ±â€Š24.1%, AG: 61.7 ±â€Š7.0%, P = .045).SICAD might be treated by conservative management in stable patients irrespective of the morphologic classification except for with type IV (dissecting aneurysm) and extension of celiac branch who may need an early intervention. Types IIb, IIIa, IIIb, and IV are TLRD are associated with patients' symptoms. Further studies on extended natural course of SICAD with a larger number of subjects are needed to draw a strong conclusion.


Assuntos
Aneurisma Dissecante/diagnóstico por imagem , Artéria Celíaca/diagnóstico por imagem , Angiografia por Tomografia Computadorizada , Adulto , Idoso , Idoso de 80 Anos ou mais , Aneurisma Dissecante/classificação , Aneurisma Dissecante/terapia , Comorbidade , Tratamento Conservador , Progressão da Doença , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Resultado do Tratamento
19.
Ann Thorac Surg ; 105(6): e239-e241, 2018 06.
Artigo em Inglês | MEDLINE | ID: mdl-29428836

RESUMO

Residual type B aortic dissection following open surgical repair of a type A thoracic aortic dissection can sometimes be complicated by collateral blood supplies, which can impact existing flow patterns and result in progressive aneurysmal dilatation of the thoracic false lumens. We report a unique case that describes the clinical presentation of an infrarenal to innominate artery collateral blood flow that complicated a chronic residual type B dissection, which was diagnosed in a timely manner using multimodality imaging, and successfully managed through an innovative minimally invasive endovascular treatment strategy (without thoracotomy) with no neurological sequela.


Assuntos
Aneurisma Dissecante/cirurgia , Aneurisma da Aorta Torácica/cirurgia , Tronco Braquiocefálico , Circulação Colateral , Complicações Pós-Operatórias , Idoso de 80 Anos ou mais , Aneurisma Dissecante/classificação , Aneurisma da Aorta Torácica/classificação , Doença Crônica , Humanos , Masculino , Complicações Pós-Operatórias/classificação
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