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1.
Emerg Med Clin North Am ; 38(2): 453-498, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32336336

RESUMO

Nontraumatic chest pain is a frequent concern of emergency department patients, with causes that range from benign to immediately life threatening. Identifying those patients who require immediate/urgent intervention remains challenging and is a high-risk area for emergency medicine physicians where incorrect or delayed diagnosis may lead to significant morbidity and mortality. This article focuses on the 3 most prevalent diagnoses associated with adverse outcomes in patients presenting with nontraumatic chest pain, acute coronary syndrome, thoracic aortic dissection, and pulmonary embolism. Important aspects of clinical evaluation, diagnostic testing, treatment, and disposition and other less common causes of lethal chest pain are also discussed.


Assuntos
Dor no Peito/diagnóstico , Serviço Hospitalar de Emergência , Gestão de Riscos , Síndrome Coronariana Aguda/complicações , Síndrome Coronariana Aguda/diagnóstico , Síndrome Coronariana Aguda/terapia , Aneurisma Dissecante/complicações , Aneurisma Dissecante/diagnóstico , Aneurisma Dissecante/terapia , Aneurisma da Aorta Torácica/complicações , Aneurisma da Aorta Torácica/diagnóstico , Aneurisma da Aorta Torácica/terapia , Dor no Peito/etiologia , Dor no Peito/terapia , Humanos , Embolia Pulmonar/complicações , Embolia Pulmonar/diagnóstico , Embolia Pulmonar/terapia , Gestão de Riscos/métodos
4.
Vasc Endovascular Surg ; 54(1): 89-92, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31551026

RESUMO

Endovascular stent placement (ESP) for patient with spontaneous isolated dissection of the superior mesenteric artery (SIDSMA) is a widely accepted treatment option. However, failed percutaneous ESP is not uncommon and is one of the leading causes for laparotomy. We report a case of 63-year-old man with SIDSMA encountered failed antegrade recanalization via conventional transfemoral approach. We achieved recanalization in a retrograde fashion through middle colic artery using rendezvous technique and successfully placed self-expandable stents inside the dissected superior mesenteric artery. The patient recovered well after percutaneous ESP. We herein describe the transcollateral retrograde approach of percutaneous ESP for SIDSMA as an alternative option when conventional antegrade recanalization fails.


Assuntos
Aneurisma Dissecante/terapia , Circulação Colateral , Procedimentos Endovasculares/métodos , Artéria Mesentérica Superior , Circulação Esplâncnica , Aneurisma Dissecante/diagnóstico por imagem , Aneurisma Dissecante/fisiopatologia , Procedimentos Endovasculares/instrumentação , Humanos , Masculino , Artéria Mesentérica Superior/diagnóstico por imagem , Artéria Mesentérica Superior/fisiopatologia , Pessoa de Meia-Idade , Stents , Resultado do Tratamento
5.
Ann Vasc Surg ; 62: 310-317, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31449959

RESUMO

BACKGROUND: This study aimed to assess the safety and efficacy of EXOSEAL vascular closure device (EVCD) insertion by comparing its performance with manual compression (MC) in achieving hemostasis at the brachial artery puncture site. METHODS: A retrospective study of brachial artery access by using either MC or EVCD for achieving hemostasis from March 2016 to October 2017 was conducted. Patients with Stanford type B aortic dissection (TBAD) undergoing percutaneous transbrachial procedures were included. Time to hemostasis (TTH) was the primary efficacy end point. Seven-day incidence of major access site-related complications was the primary safety end point. TTH and major and minor complications associated with treatment of these 2 groups were also evaluated. RESULTS: A total of 157 patients with TBAD undergoing percutaneous transbrachial procedures entered the analysis. Of these, 107 patients underwent EVCD insertion and 50 patients underwent MC. The baseline characteristics of the 2 groups were similar. TTH was significantly shorter for EVCD over MC (P < 0.05). The TTH ≥10 min in the MC group was 100.0% (n = 50), but in the EVCD group, it was ≤2 min, 87.9% (n = 107); 2-5 min, 7.5% (n = 107); and ≥10 min, 4.7% (n = 107). The EVCD group had several major complications, while the MC group had none. Two patients (1.9%, n = 107) required vascular repair, one patient (0.6%, n = 107) required blood transfusion, and 1 patient (0.6%, n = 107) developed upper limb numbness and weakness after EVCD deployment. Minor complication such as the occurrence of hematoma (≤5 cm) in the MC group was 4 (8.0%) but was also 4 (3.7%) in the EVCD group, showing statistically significant difference (P = 0.030). The incidence of ecchymosis was 8 (7.5%) in the EVCD group when compared with 13 (26.0%) in the MC group, which showed statistically significant difference (P = 0.001). Other major and minor complications showed no significant differences between these 2 groups. CONCLUSIONS: After invasive procedures by 6F percutaneous access via the brachial artery in preprocedurally fully anticoagulated patients, TTH was significantly reduced in patients who underwent EVCD when compared with patients who underwent MC. MC is a safer and more convenient way to achieve hemostasis but has higher incidence of minor complications.


Assuntos
Aneurisma Dissecante/terapia , Aneurisma Aórtico/terapia , Artéria Braquial , Cateterismo Periférico , Hemorragia/prevenção & controle , Hemostasia , Técnicas Hemostáticas/instrumentação , Dispositivos de Oclusão Vascular , Adulto , Idoso , Cateterismo Periférico/efeitos adversos , Pesquisa Comparativa da Efetividade , Desenho de Equipamento , Feminino , Hemorragia/sangue , Hemorragia/etiologia , Técnicas Hemostáticas/efeitos adversos , Humanos , Masculino , Pessoa de Meia-Idade , Pressão , Punções , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento
6.
Int Heart J ; 60(6): 1373-1380, 2019 Nov 30.
Artigo em Inglês | MEDLINE | ID: mdl-31666449

RESUMO

It has been shown in previous studies that Chinese patients with acute aortic dissection (AD) were approximately 10 years younger than patients from western countries. However, there is a lack of studies concerning the age-related differences in clinical characteristics and outcomes in Chinese patients with acute AD. A total of 1,061 patients with AD (570 type A and 491 type B AD) were enrolled between 2006 and 2008. The clinical characteristics were compared between the patients in our study and those in the International Registry of Acute Aortic Dissection (IRAD). Compared with patients in the IRAD, those in our study were relatively younger, comprised more males, and had a higher proportion of Marfan syndrome but received fewer surgical interventions. When stratified by 10-year age, younger patients were more likely to have type A AD, familial AD, and Marfan syndrome, whereas older patients tended to comprise more females and type B AD. As age increased, the proportion of surgical intervention gradually decreased regardless of the type of AD. During a median follow-up of 2.2 years, 147 patients died, of whom 94 (63.9%) had type A AD and 53 (36.1%) had type B AD. Long-term mortality increased with increasing age, especially in patients above 70 years old. Furthermore, the recurrence rate of AD was higher in both the young and the older patients. In conclusion, compared with western patients with AD, Chinese patients have distinct characteristics and more attention should be paid to the young and older patients because of their high long-term mortality and recurrence rate.


Assuntos
Aneurisma Dissecante/complicações , Aneurisma Dissecante/terapia , Aneurisma Aórtico/complicações , Aneurisma Aórtico/terapia , Grupo com Ancestrais do Continente Asiático , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Aneurisma Dissecante/epidemiologia , Aneurisma Aórtico/epidemiologia , Aneurisma da Aorta Torácica/epidemiologia , China , Feminino , Humanos , Masculino , Síndrome de Marfan/epidemiologia , Pessoa de Meia-Idade , Recidiva , Taxa de Sobrevida , Resultado do Tratamento , Adulto Jovem
7.
Vnitr Lek ; 65(7-8): 506-514, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31487994

RESUMO

Acute aortic syndromes are emergent life-threatening conditions affecting the aorta, which actual incidence is difficult to determine. Mortality of untreated patients increases steadily over time, so early diagnosis and initiation of therapy are crucial. Management of patients in Czech Republic follow, similar as in other European countries, the European Society of Cardiology guidelines from 2014, which were updated in 2018. The basis for diagnosis consists of history, physical examination, ECG, determination of vital signs, hemodynamic status and stratification of dia-gnosis probability by ADD-RS (aortic dissection detection risk score). This is followed by a series of laboratory and imaging examinations, of which the D-dimer, CT aortography and echocardiography are the most important. Recent studies show the benefit of combination of ADD-RS with D-dimer or measurement of ascendant aorta diameter by echocardiography. New emerging biomarkers are currently under investigation. Thanks to advances in technology, magnetic resonance imaging could take place as emergent diagnostic tool in the future. Initial therapy depends on the hemodynamic status of the patient. It must be followed by definitive therapy. In this publication we summarize the approach to a patient with acute aortic syndrome in the emergency department focusing on aortic dissection as its most common type.


Assuntos
Aneurisma Dissecante , Aneurisma Aórtico , Aneurisma Dissecante/diagnóstico , Aneurisma Dissecante/terapia , Aorta , Aneurisma Aórtico/diagnóstico , Aneurisma Aórtico/terapia , República Tcheca , Serviço Hospitalar de Emergência/estatística & dados numéricos , Europa (Continente) , Humanos , Síndrome
8.
J Stroke Cerebrovasc Dis ; 28(11): 104374, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31530480

RESUMO

Traumatic cerebral aneurysms are histologically dissecting aneurysms or pseudoaneurysms, thus requiring parent artery occlusion for cure. Combination of endovascular parent artery occlusion and extracranial-intracranial bypass is considered optimal to obtain complete obliteration of the aneurysm and to avoid hemodynamic hypoperfusion. However, endovascular parent artery occlusion of the supraclinoid internal carotid artery (ICA) is at risk of ischemic complications due to distal coil protrusion to adjacent perforating arteries or distal embolism of the thrombi generated in the coil mass. A 20-year-old man presented with progressive left optic neuropathy following motor vehicle accident. Radiological examination revealed left supraclinoid ICA aneurysmal formation with dissecting change. We treated this traumatic supraclinoid ICA aneurysm by combination of endovascular parent artery occlusion and high-flow bypass in the hybrid operating room. An aneurysmal clip was applied on the ICA just distal to the aneurysm prior to coil embolization, and worked as a scaffold for subsequent filling coils and as a blockade for the distal emboli. This "clip anchor-assisted coil embolization" technique resulted in optimal parent artery occlusion for the traumatic aneurysm of the supraclinoid ICA with minimal risks of residual blood flow, intraoperative rupture, and thromboembolic complications.


Assuntos
Acidentes de Trânsito , Aneurisma Dissecante/terapia , Embolização Terapêutica/instrumentação , Procedimentos Endovasculares/instrumentação , Aneurisma Intracraniano/terapia , Artéria Radial/transplante , Enxerto Vascular , Aneurisma Dissecante/diagnóstico por imagem , Aneurisma Dissecante/fisiopatologia , Velocidade do Fluxo Sanguíneo , Circulação Cerebrovascular , Humanos , Aneurisma Intracraniano/diagnóstico por imagem , Aneurisma Intracraniano/fisiopatologia , Masculino , Resultado do Tratamento , Adulto Jovem
9.
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
10.
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
11.
Nat Commun ; 10(1): 3184, 2019 07 18.
Artigo em Inglês | MEDLINE | ID: mdl-31320641

RESUMO

Thoracic aortic dissection (TAD) is an aggressive vascular disease that requires early diagnosis and effective treatment. However, due to the particular vascular structure and narrowness of lesion location, there are no effective drug delivery systems for the therapy of TAD. Here, we report a multifunctional delivery nanosystem (TP-Gd/miRNA-ColIV) composed of gadolinium-chelated tannic acid (TA), low-toxic cationic PGEA (ethanolamine-aminated poly(glycidyl methacrylate)) and type IV collagen targeted peptide (ColIV) for targeted nucleic acid therapy, early diagnosis and noninvasive monitoring of TAD. Such targeted therapy with miR-145 exhibits impressive performances in stabilizing the vascular structures and preventing the deterioration of TAD. After the treatment with TP-Gd/miR-145-ColIV, nearly no dissection occurs in the thoracic aortic arches of the mice with TAD model. Moreover, TP-Gd/miRNA-ColIV also demonstrates good magnetic resonance imaging (MRI) ability and can be used to noninvasively monitor the development conditions of TAD.


Assuntos
Aneurisma Dissecante/terapia , Aneurisma da Aorta Torácica/terapia , Sistemas de Liberação de Medicamentos/métodos , Terapia Genética/métodos , MicroRNAs/administração & dosagem , MicroRNAs/uso terapêutico , Aneurisma Dissecante/patologia , Animais , Aneurisma da Aorta Torácica/patologia , Células Cultivadas , Colágeno Tipo IV/química , Gadolínio/química , Masculino , Camundongos , Camundongos Endogâmicos C57BL , MicroRNAs/genética , Ácidos Polimetacrílicos/química , Taninos/química , Artérias Torácicas/patologia
12.
J Stroke Cerebrovasc Dis ; 28(9): e129-e131, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31296478

RESUMO

Intracranial artery dissection secondary to autosomal dominant polycystic kidney disease is far less common than cerebral aneurysm. A 55-year-old man presented a sudden onset of headache and disturbed consciousness caused by ischemic stroke in the bilateral frontal lobes with minor subarachnoid hemorrhage. The bilateral anterior cerebral arteries were firstly occluded and re-perfused with irregular narrowing and dilation in 3 days after stroke onset, indicating dissection. He was diagnosed with autosomal dominant polycystic kidney disease by abdominal CT findings and by his family history though his renal function was almost normal. Dissection in the anterior cerebral artery has not been reported previously, while some cases with dissection in the vertebral and extracranial arteries were reported in autosomal dominant polycystic kidney disease. His family also had a history of aortic dissection and subarachnoid hemorrhage. Intracranial artery dissection may be a manifestation of systemic arteriopathy with familial clustering in autosomal dominant polycystic kidney disease. Strict antihypertensive treatment is needed in these cases.


Assuntos
Aneurisma Dissecante/etiologia , Aneurisma Intracraniano/etiologia , Rim Policístico Autossômico Dominante/complicações , Aneurisma Dissecante/diagnóstico por imagem , Aneurisma Dissecante/terapia , Angiografia Cerebral/métodos , Tratamento Conservador , Imagem de Difusão por Ressonância Magnética , Humanos , Aneurisma Intracraniano/diagnóstico por imagem , Aneurisma Intracraniano/terapia , Angiografia por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Rim Policístico Autossômico Dominante/diagnóstico , Tomografia Computadorizada por Raios X
13.
Neuroradiol J ; 32(5): 353-365, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31271334

RESUMO

INTRODUCTION: Blister and dissecting aneurysms may have a different pathological background but they are commonly defined by instability of the vessel wall and bear a high risk of fatal rupture and rerupture. Lack of aneurysm sack makes treatment challenging. PURPOSE: The purpose of this study was to assess the safety and feasibility of endovascular treatment of intracranial blister and dissecting aneurysms. METHODS: We retrospectively analysed all patients with ruptured and unruptured blister and dissecting aneurysms treated endovascularly between 2004-2018. Procedural details, complications, morbidity/mortality, clinical favourable outcome (modified Rankin Scale ≤2) and aneurysm occlusion rates were assessed. RESULTS: Thirty-four patients with endovascular treatment of 35 aneurysms (26 dissecting aneurysms and 9 blister aneurysms) were included. Five aneurysms were treated by parent vessel occlusion, and 30 aneurysms were treated by vessel reconstruction using stent monotherapy (n = 9), stent-assisted coiling (n = 7), flow diverting stents (n = 13) and coiling + Onyx embolization (n = 1). No aneurysm rebleeding and no procedure-related major complications or deaths occurred. There were five deaths in consequence of initial subarachnoid haemorrhage. Complete occlusion (79.2%) was detected in 19/24 aneurysms available for angiographic follow-up, and aneurysm recurrence in 2/24 (8.3%). The modified Rankin Scale ≤2 rate at mean follow-up of 15.1 months was 64.7%. CONCLUSION: Treatment of blister and dissecting aneurysms developed from coil embolization to flow diversion with multiple stents to the usage of flow diverting stents. Results using modern flow diverting stents encourage us to effectively treat this aneurysm entity endovascularly by vessel reconstruction. Therefore, we recommend preference of vessel reconstructive techniques to parent vessel occlusion.


Assuntos
Aneurisma Dissecante/terapia , Embolização Terapêutica/métodos , Procedimentos Endovasculares/métodos , Aneurisma Intracraniano/terapia , Adulto , Idoso , Vesícula/cirurgia , Embolização Terapêutica/instrumentação , Estudos de Viabilidade , Humanos , Angiografia por Ressonância Magnética , Pessoa de Meia-Idade , Segurança do Paciente , Estudos Retrospectivos , Resultado do Tratamento , Adulto Jovem
14.
Angiol Sosud Khir ; 25(2): 65-79, 2019.
Artigo em Inglês, Russo | MEDLINE | ID: mdl-31149992

RESUMO

Analysed herein is efficacy of hybrid intervention according to the 'frozen elephant trunk' procedure in the medium-term period of follow-up in patients operated on for aortic dissection. During the period from 2012 to 2018, a total of 44 'frozen elephant trunk' procedures were carried out for Stanford type A and B thoracic aortic dissections. All interventions were performed in conditions of moderate hypothermic circulatory arrest (25-28 °C) with unilateral cerebral perfusion through the brachiocephalic trunk. The mean diameter of the implanted stent grafts amounted to 27.7±2.8 mm (range 24-30 mm). The distal edge of the stent graft was located at the level below the Th9 in more than 65% of cases (range Th7-Th12). The stent grafts were fixed proximally at the levels Z0-Z3, predominantly in the Z3 zone (72.7%). Thirty-day mortality amounted to 6.8%, with in-hospital mortality of 15.9%. Five-year survival in acute and chronic type A aortic dissection (AD) amounted to 100 and 80%, respectively (p=0.175). In acute type B aortic dissection five-year survival amounted to 62.2%, being 25.0% for chronic AD (p=0.057). Freedom from reinterventions for acute and chronic type A aortic dissection amounted to 100 and 66.7%, respectively (p=0.286). Freedom from aortic reinterventions for acute and chronic type B aortic dissection amounted to 100% and 75%, respectively (p=0.123). Reconstructive operations performed according to the 'frozen elephant trunk' technique appear to be effective surgical treatment in patients with thoracic aortic dissection, yielding satisfactory clinical results during a medium-term follow-up period.


Assuntos
Aneurisma Dissecante , Aneurisma da Aorta Torácica , Implante de Prótese Vascular , Aneurisma Dissecante/terapia , Aneurisma da Aorta Torácica/terapia , Mortalidade Hospitalar , Humanos , Stents , Resultado do Tratamento
15.
Semin Thorac Cardiovasc Surg ; 31(4): 628-634, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31212014

RESUMO

Nonsyndromic thoracic aortic aneurysm and dissection (TAAD) account for 95% of all TAAD cases and comprise a subset in which the lack of obvious clinical signs makes diagnosis a challenge. Despite the potentially fatal natural history, timely diagnosis and prophylactic surgical intervention allow restoration of near-normal life expectancy in TAAD patients, underlining the critical importance of screening tests. To date, more than 30 TAAD disease-causing genes have been identified, and over 30% of nonsyndromic TAAD patients have a genetic mutation in 1 or more of these genes. Whole exome sequencing allows routine genetic testing in a clinical setting by screening for all TAAD-related genes, thus facilitating personalized aortic care. Additionally, increased vigilance upon diagnosis of certain TAAD-related diseases ("guilty associates") and the emergence of modern radiologic and novel serologic screening tests will further bolster efforts to detect undiagnosed asymptomatic nonsyndromic TAAD.


Assuntos
Aneurisma Dissecante/genética , Aneurisma da Aorta Torácica/genética , Testes Genéticos/métodos , Mutação , Sequenciamento Completo do Exoma , Aneurisma Dissecante/diagnóstico por imagem , Aneurisma Dissecante/terapia , Aneurisma da Aorta Torácica/diagnóstico por imagem , Aneurisma da Aorta Torácica/terapia , Predisposição Genética para Doença , Hereditariedade , Humanos , Linhagem , Fenótipo , Valor Preditivo dos Testes , Prognóstico , Medição de Risco , Fatores de Risco
17.
Biomed Res Int ; 2019: 1420216, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31119151

RESUMO

Background: Continued debates exist regarding the optimal temperature during hypothermic circulatory arrest in aortic arch repair for patients with type A aortic dissection. This study seeks to examine whether the use of moderate hypothermic circulatory arrest in a pig model provides comparable vital organ protection outcomes to the use of deep hypothermic circulatory arrest. Methods: Thirteen pigs were randomly assigned to 30 minutes of hypothermic circulatory arrest without cerebral perfusion at 15°C (n = 5), 25°C (n = 5), and a control group (n = 3). The changes in standard laboratory tests and capacity for protection against apoptosis in different vital organs were monitored with different temperatures of hypothermic circulatory arrest management in pig model to determine which temperature was optimal for hypothermic circulatory arrest. Results: There were no significant differences in the capacity for protection against apoptosis in vital organs between 2 groups (p > 0.05, respectively). Compared with the moderate hypothermic circulatory arrest group, the deep hypothermic circulatory arrest group had no significant advantages in terms of the biologic parameters of any other organs (p > 0.05). Conclusions: Compared with deep hypothermic circulatory arrest, moderate hypothermic circulatory arrest is a moderate technique that has similar advantages with regard to the levels of biomarkers of injury and capacity for protection against apoptosis in vital organs.


Assuntos
Apoptose/genética , Parada Circulatória Induzida por Hipotermia Profunda , Hipotermia Induzida , Miocárdio/metabolismo , Aneurisma Dissecante/genética , Aneurisma Dissecante/patologia , Aneurisma Dissecante/terapia , Animais , Aorta Torácica/metabolismo , Aorta Torácica/patologia , Encéfalo/irrigação sanguínea , Encéfalo/metabolismo , Caspase 3/genética , Circulação Cerebrovascular/genética , Parada Cardíaca Induzida/métodos , Humanos , Rim/irrigação sanguínea , Rim/metabolismo , Fígado/irrigação sanguínea , Fígado/metabolismo , Miocárdio/patologia , Proteínas Proto-Oncogênicas c-bcl-2/genética , Suínos , Proteína X Associada a bcl-2/genética
18.
Cardiovasc Intervent Radiol ; 42(8): 1095-1101, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31093718

RESUMO

PURPOSE: To analyze factors potentially associated with the occurrence of distal edge stenosis after stent placement for isolated superior mesenteric artery dissection (ISMAD). MATERIALS AND METHODS: Cases of consecutive patients who were diagnosed with spontaneous ISMAD between February 2010 and July 2018 were retrospectively identified. Of the 123 cases identified, 45 patients (42 men; three women) underwent endovascular stent placement and were included in the study. Univariate and multivariate analyses were used to assess factors potentially associated with distal edge stenosis. RESULTS: The technical success rate among study patients was 100%. During 26.7 ± 17.3 months of follow-up, CT angiography demonstrated good distal edge patency in 25 patients (55.6%) and evidence of distal edge stenosis in 20 patients (44.4%). In univariate analysis, stent length (odds radio [OR] 1.03; 95% confidence interval [CI] 1.01, 1.06; P = .02), stent-to-vessel (S/V) diameter ratio (OR 2.27; 95% CI 1.35, 3.82; P < .01), and angulation at the distal edge (OR 1.05; 95% CI 1.00, 1.10; P =.03) were significantly associated with distal edge stenosis; only S/V diameter ratio (OR 3.36; 95% CI 1.41, 7.99; P < .01) and angulation at the distal edge (OR 1.12; 95% CI 1.01, 1.23; P =.03) retained this significance in multivariate analysis. CONCLUSIONS: Distal edge stenosis after stent placement for ISMAD is common. S/V diameter ratio and angulation at the distal edge are independent risk factors for distal edge stenosis in patients with ISMAD who undergo stent placement.


Assuntos
Aneurisma Dissecante/terapia , Arteriopatias Oclusivas/terapia , Artéria Mesentérica Superior/patologia , Stents , Adulto , Idoso , Aneurisma Dissecante/diagnóstico por imagem , Arteriopatias Oclusivas/diagnóstico por imagem , Arteriopatias Oclusivas/patologia , Angiografia por Tomografia Computadorizada , Análise Fatorial , Feminino , Humanos , Masculino , Artéria Mesentérica Superior/diagnóstico por imagem , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Sensibilidade e Especificidade , Resultado do Tratamento
19.
Zhonghua Wai Ke Za Zhi ; 57(5): 326-330, 2019 May 01.
Artigo em Chinês | MEDLINE | ID: mdl-31091585

RESUMO

Despite the improvements in the diagnosis and management during the past six decades, acute aortic dissection (AAD) remains a life-threatening condition associated with significant morbidity and mortality rates. Due to the relatively rare occurrence of AAD, several clinical registries have been established to gain insights into this lethal disease in a large number of patients, such as the International Registry of Acute Aortic Dissection (IRAD), the German Registry for Acute Aortic Dissection Type A (GERAADA), and the Society of Thoracic Surgeons (STS) Adult Cardiac Surgery Database Aortic Section. This review aims to interpret and compare the latest results of the IRAD, STS and GERAADA database. It focuses on several controversial and key issues in the diagnosis and management of acute aortic dissection in hope of providing some insights and references for cardiovascular professionals engaged in the care of this deadly disease.


Assuntos
Aneurisma Dissecante/diagnóstico , Aneurisma Dissecante/terapia , Aneurisma Aórtico/diagnóstico , Aneurisma Aórtico/terapia , Sistema de Registros , Doença Aguda , Procedimentos Cirúrgicos Cardíacos , Humanos
20.
Braz J Cardiovasc Surg ; 34(5): 596-604, 2019 12 01.
Artigo em Inglês | MEDLINE | ID: mdl-31112020

RESUMO

Aortic dissection (AD) has been recognized to be associated with an inflammatory process. Clinical observations demonstrated that patients with AD had an elevated interleukin (IL)-6 level in comparison to hypertensive or healthy controls. Adverse events such as acute lung injury, postimplantation syndrome, and death are associated with an elevated IL-6 level. Thus, circulating IL-6 could be a reliable biomarker for the diagnosis of AD and for the eveluation of the therapeutic outcomes and the prognosis of AD patients. Therapeutic interventions aiming at attenuating the inflammatory status by IL-6 neutralization could effectively decrease the IL-6 level and thus reverse the progression of the disorder of AD patient. Endovascular aortic repair can effectively control the inflammatory cytokines. Selective antegrade cerebral perfusion with deep hypothermic circulatory arrest during aortic arch replacement shows better neuroprotectve effect with an improved IL-6 level of the cerebrospinal fluid. These results facilitate the understanding of the etiology of AD and guide the directions for the treatment of acute AD in the future. More effective therapeutic agents developed based on the theories of IL-6 signaling involved in the mechasims of AD are anticipated.


Assuntos
Aneurisma Dissecante/metabolismo , Aneurisma Aórtico/metabolismo , Interleucina-6/análise , Aneurisma Dissecante/diagnóstico , Aneurisma Dissecante/terapia , Aneurisma Aórtico/diagnóstico , Aneurisma Aórtico/terapia , Citocinas/análise , Humanos , Valor Preditivo dos Testes , Prognóstico , Valores de Referência , Fatores de Tempo
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