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1.
Sultan Qaboos Univ Med J ; 21(1): e116-e119, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33777432

RESUMO

Objectives: This study aimed to discuss the different challenges faced while managing emergency vascular surgery cases during the COVID-19 pandemic and how these challenges were overcome. Methods: This study details 14 emergency cases that were managed during a period of one month from mid-March to mid-April at Sultan Qaboos University Hospital, Muscat, Oman. The cases included acute limb ischaemia, critical limb ischaemia, type B dissection of the thoracic aorta, thoraco-abdominal aneurysm, critical internal carotid artery stenosis, trauma, infected arteriovenous forearm loop graft and thrombosed arteriovenous fistulas. Results: Only one patient was confirmed to have COVID-19. Five were negative for COVID-19 while the remaining eight were not tested. Various strategies on how the vascular surgical team accommodated changes in hospital protocols and nationwide lockdown are discussed in detail. Conclusions: With the judicious use of personal protective equipment and consumable surgical and endovascular devices, communication with support services and other hospitals and implementation of triage protocols, it was possible to manage vascular surgery emergencies effectively.


Assuntos
COVID-19/diagnóstico , Emergências , Encaminhamento e Consulta , Doenças Vasculares/terapia , Procedimentos Cirúrgicos Vasculares/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Amputação/métodos , Aneurisma Dissecante/terapia , Angioplastia/métodos , Aneurisma Aórtico/terapia , Derivação Arteriovenosa Cirúrgica , COVID-19/complicações , Estenose das Carótidas/terapia , Gerenciamento Clínico , Embolectomia/métodos , Feminino , Oclusão de Enxerto Vascular/complicações , Oclusão de Enxerto Vascular/terapia , Humanos , Isquemia/terapia , Extremidade Inferior , Masculino , Pessoa de Meia-Idade , Omã , SARS-CoV-2 , Centros de Atenção Terciária , Extremidade Superior
2.
Semin Vasc Surg ; 34(1): 10-17, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33757630

RESUMO

Aortic dissection remains a highly morbid diagnosis. The treatment of aortic dissection has undergone several paradigm shifts since it was first understood. However, despite the robust research in treatment, the epidemiology of aortic dissection is limited. In this review, we discuss the historical perspectives of aortic dissection with a review of risk factors and presentation. We review the trends in incidence during the past 40 years, with consideration for sex, race, and ethnicity in admission. We further focus our discussion of the classically described Type B aortic dissection treatment. Lastly, we review the impact of long-term events, readmissions, cost assessments, and quality of life studies of patients with aortic dissection. Care for those with aortic dissection remains a long-term challenge for providers and a multispecialty approach is needed for complete patient management.


Assuntos
Aneurisma Dissecante/epidemiologia , Aneurisma Aórtico/epidemiologia , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Aneurisma Dissecante/diagnóstico por imagem , Aneurisma Dissecante/terapia , Aneurisma Aórtico/diagnóstico por imagem , Aneurisma Aórtico/terapia , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Qualidade de Vida , Fatores Raciais , Medição de Risco , Fatores de Risco , Fatores Sexuais , Resultado do Tratamento , Estados Unidos/epidemiologia
3.
Am J Physiol Heart Circ Physiol ; 320(5): H1786-H1801, 2021 05 01.
Artigo em Inglês | MEDLINE | ID: mdl-33635167

RESUMO

Thoracic aortic aneurysm and dissection (TAAD) is a deadly disease characterized by intimal disruption induced by hemodynamic forces of the circulation. The effect of exercise in patients with TAAD is largely unknown. ß-Aminopropionitrile (BAPN) is an irreversible inhibitor of lysyl oxidase that induces TAAD in mice. The objective of this study was to investigate the effect of aerobic exercise on BAPN-induced TAAD. Upon weaning, mice were given either BAPN-containing water or standard drinking water and subjected to either conventional cage activity (BAPN-CONV) or forced treadmill exercise (BAPN-EX) for up to 26 wk. Mortality was 23.5% (20/85) for BAPN-CONV mice versus 0% (0/22) for BAPN-EX mice (hazard ratio 3.8; P = 0.01). BAPN induced significant elastic lamina fragmentation and intimal-medial thickening compared with BAPN-untreated controls, and aneurysms were identified in 50% (5/10) of mice that underwent contrast-enhanced CT scanning. Exercise significantly decreased BAPN-induced wall thickening, calculated circumferential wall tension, and lumen diameter, with 0% (0/5) of BAPN-EX demonstrating chronic aortic aneurysm formation on CT scan. Expression of selected genes relevant to vascular diseases was analyzed by qRT-PCR. Notably, exercise normalized BAPN-induced increases in TGF-ß pathway-related genes Cd109, Smad4, and Tgfßr1; inflammation-related genes Vcam1, Bcl2a1, Ccr2, Pparg, Il1r1, Il1r1, Itgb2, and Itgax; and vascular injury- and response-related genes Mmp3, Fn1, and Vwf. Additionally, exercise significantly increased elastin expression in BAPN-treated animals compared with controls. This study suggests that moderate aerobic exercise may be safe and effective in preventing the most devastating outcomes in TAAD.NEW & NOTEWORTHY Moderate aerobic exercise was shown to significantly reduce mortality, extracellular matrix degradation, and thoracic aortic aneurysm and dissection formation associated with lysyl oxidase inhibition in a mouse model. Gene expression suggested a reversal of TGF-ß, inflammation, and extracellular matrix remodeling pathway dysregulation, along with augmented elastogenesis with exercise.


Assuntos
Aneurisma Dissecante/terapia , Aorta Torácica/patologia , Aneurisma da Aorta Torácica/terapia , Ruptura Aórtica/prevenção & controle , Terapia por Exercício , Matriz Extracelular/patologia , Remodelação Vascular , Aminopropionitrilo , Aneurisma Dissecante/induzido quimicamente , Aneurisma Dissecante/metabolismo , Aneurisma Dissecante/patologia , Animais , Aorta Torácica/metabolismo , Aorta Torácica/fisiopatologia , Aneurisma da Aorta Torácica/induzido quimicamente , Aneurisma da Aorta Torácica/metabolismo , Aneurisma da Aorta Torácica/patologia , Ruptura Aórtica/induzido quimicamente , Ruptura Aórtica/metabolismo , Ruptura Aórtica/patologia , Dilatação Patológica , Modelos Animais de Doenças , Progressão da Doença , Matriz Extracelular/metabolismo , Proteínas da Matriz Extracelular/metabolismo , Regulação da Expressão Gênica , Hemodinâmica , Masculino , Camundongos Endogâmicos C57BL , Proteólise , Transdução de Sinais
4.
Medicine (Baltimore) ; 100(6): e24732, 2021 Feb 12.
Artigo em Inglês | MEDLINE | ID: mdl-33578619

RESUMO

ABSTRACT: The aim of this study is to describe our clinical outcomes in isolated superior mesenteric artery dissection (SMAD) patients that underwent uncovered stent insertion.Between January 2016 and August 2019, consecutive isolated SMAD patients at our center were treated via uncovered stent insertion. Both short- and long-term outcomes in these patients were analyzed.Over the course of the study period, 11 total isolated SMAD patients meeting the criteria for stent insertion at our hospital were treated via uncovered stent insertion. Stent placement across the SMAD site was successful in all patients, with 1 stent being used per patient. There were no instances of procedure-related complications, and the median operative duration was 60 minutes. Patency of the distal superior mesenteric artery and branches thereof was achieved in all cases. Patients experienced progressive SMAD-related symptom relief and were followed for 6 to 49 months (median: 22 months). Over this follow-up period, the obliteration of the dissection was observed within 3 months in all patients. We did not detect any instances of stent occlusion, bowel ischemia, or anti-platelet-related bleeding during the follow-up period.Uncovered stent insertion can achieve favorable short- and long-term outcomes in isolated SMAD patients.


Assuntos
Aneurisma Dissecante/terapia , Artéria Mesentérica Superior , Idoso , Aneurisma Dissecante/diagnóstico por imagem , Angiografia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Radiografia Intervencionista , Estudos Retrospectivos , Stents
6.
PLoS One ; 15(8): e0237989, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32834010

RESUMO

BACKGROUND: Acute type A aortic dissection (ATAAD) is a life-threatening disease that requires emergent surgical intervention. This retrospective study aimed to clarify the individual characteristics, short-term and mid-term outcomes, and prognostic factors of patients who underwent surgical repair of ATAAD with preoperative cardiopulmonary resuscitation (CPR). METHODS: Between January 2007 and January 2020, 656 consecutive patients underwent ATAAD repair at our institution; 22 (3.4%) of these patients underwent CPR prior to surgery. Patients who underwent preoperative CPR were classified as the survivor group (n = 9) and non-survivor group (n = 13), according to whether they survived to hospital discharge. Clinical features, surgical information, and postoperative complications were analyzed and compared. Three-year cumulative survival rates and cerebral performance categories (CPC) scores are presented. RESULTS: In patients undergoing CPR prior to ATAAD surgery, the in-hospital mortality rate was 59.1%. A total of 72.7% of patients underwent concomitant surgical resuscitation procedures during CPR such as emergent subxiphoid pericardiotomy and/or emergent cardiopulmonary bypass. The survivor group had a higher rate of return of spontaneous heartbeat (ROSB) compared to the non-survivor group (100% versus 53.8%; P = 0.017). The 3-year cumulative survival rates were 35.1% (95% confidence interval [CI], 27.6%-42.6%) and 85.7% (95% CI, 81.9%-88.8%) for overall patients and for survivors, respectively. As for the neurological outcome, 77.8% (7/9) of patients had full cerebral performance (CPC-1) at the 3-month follow-up examination after discharge. CONCLUSIONS: Patients with ATAAD undergoing preoperative CPR, especially those without ROSB after CPR, are at high risk for in-hospital mortality. However, the short-term and mid-term outcomes, including the cerebral performance after discharge and 3-year survival rate, are promising for patients who survived to discharge.


Assuntos
Aneurisma Dissecante/cirurgia , Reanimação Cardiopulmonar , Período Pré-Operatório , Doença Aguda , Idoso , Idoso de 80 Anos ou mais , Aneurisma Dissecante/fisiopatologia , Aneurisma Dissecante/terapia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neurologia , Análise de Sobrevida , Resultado do Tratamento
7.
Zhonghua Wai Ke Za Zhi ; 58(8): 604-607, 2020 Aug 01.
Artigo em Chinês | MEDLINE | ID: mdl-32727191

RESUMO

Aortic dissection is a life-threatening cardiovascular disease. Multi-center registration databases for aortic dissection have been established in many countries. The International Registry of Acute Aortic Dissection has produced a number of research results, which had a significant impact on the diagnosis and treatment of aortic dissection worldwide. The Society for Thoracic Surgeons Adult Cardiac Surgery Database summarizes perioperative data on aortic dissection. German Registry for Acute Aortic Dissection Type A has made remarkable achievements in the neurological protection and organ perfusion of type A aortic dissection. The Nordic Consortium for Acute Type A Aortic Dissection provides guidelines for perioperative administration of aortic dissection. However, the first Registry of Aortic Dissection in China (Sino-RAD) has not reported any new aortic dissection data in the past five years, although it has proposed a number of pathogenic characteristics of Chinese people. Therefore, it is necessary to establish our own aortic dissection database.


Assuntos
Aneurisma Dissecante , Aneurisma Aórtico , Sistema de Registros , Aneurisma Dissecante/diagnóstico , Aneurisma Dissecante/cirurgia , Aneurisma Dissecante/terapia , Aneurisma Aórtico/diagnóstico , Aneurisma Aórtico/cirurgia , Aneurisma Aórtico/terapia , Humanos
8.
Asian Cardiovasc Thorac Ann ; 28(8): 512-519, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32674584

RESUMO

Acute aortic syndrome is a group of interlinked conditions with common presenting symptoms, including aortic dissection, penetrating atherosclerotic ulcer, and intramural hematoma. Pharmacological management of acute aortic syndrome is a growing area, with key themes to address the underlying inflammatory pathways believed to be the cause. Research into interleukins, matrix metalloproteinases, and granulocyte macrophage colony-stimulating factor are just some of the many immunological properties being investigated and translated into medical therapies. Stem cell experiments may indicate further advances in the pathologies of acute aortic syndrome. The study of pharmacogenomics to improve treatment across different genomes is also a novel area outlined in this paper.


Assuntos
Aneurisma Dissecante/terapia , Aneurisma Aórtico/terapia , Hematoma/terapia , Fatores Imunológicos/uso terapêutico , Imunoterapia , Transplante de Células-Tronco , Úlcera/terapia , Aneurisma Dissecante/diagnóstico por imagem , Aneurisma Dissecante/genética , Aneurisma Dissecante/imunologia , Aneurisma Aórtico/diagnóstico por imagem , Aneurisma Aórtico/genética , Aneurisma Aórtico/imunologia , Hematoma/diagnóstico por imagem , Hematoma/genética , Hematoma/imunologia , Humanos , Fatores Imunológicos/efeitos adversos , Transplante de Células-Tronco/efeitos adversos , Síndrome , Úlcera/diagnóstico por imagem , Úlcera/genética , Úlcera/imunologia
9.
Ann Vasc Surg ; 69: 62-73, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32561245

RESUMO

BACKGROUND: The aim of the study was to analyze aortic-related outcomes after diagnosis of aortic dissection (AD), intramural hematoma (IMH), and penetrating aortic ulcer (PAU) from a population-based approach. METHODS: Retrospective review of an incident cohort of AD, IMH, and PAU patients in Olmsted County, Minnesota from 1995 to 2015. Primary end point was aortic death. Secondary end points were subsequent aortic events (aortic intervention, new dissection, or rupture not present at presentation) and first-time diagnosis of an aortic aneurysm. Outcomes were compared with randomly selected population referents matched for age and sex in a 3:1 ratio using Cox proportional hazards regression adjusting for comorbidities. RESULTS: Among 133 patients (77 AD, 21 IMH, and 35 PAU), 57% were males, and mean age was 71.8 years (standard deviation, 14). Median follow-up was 10 years. Of 73 deaths among AD/IMH/PAU patients, 23 (32%) were aortic-related. Estimated freedom from aortic death was 84%, 80%, and 77% at 5, 10, and 15 years. There were no aortic deaths among population referents (adjusted hazard ratio [HR] for aortic death in AD/IMH/PAU, 184.7; 95% confidence interval [95% CI], 10.3-3,299.2; P < 0.001). Fifty (38%) AD/IMH/PAU patients had a subsequent aortic event (aortic intervention, new dissection, or rupture), whereas there were 8 (2%) aortic events among population referents (all elective aneurysm repairs; adjusted HR for any aortic event and aortic intervention in AD/IMH/PAU patients, 33.3; 95% CI, 15.3-72.0; P < 0.001 and 31.5; 95% CI, 14.5-68.4; P < 0.001, respectively). After excluding aortic events/interventions ≤14 days of diagnosis, AD/IMH/PAU patients remained at increased risk of any aortic event (adjusted HR, 10.8; 95% CI, 3.9-29.8; P < 0.001) and aortic intervention (adjusted HR, 9.6; 95% CI, 3.4-26.8; P < 0.001). Among those subjects with available follow-up imaging, the risk of first-time diagnosis of aortic aneurysm was significantly increased for AD/IMH/PAU patients when compared with population referents (adjusted HR, 10.9; 95% CI, 5.4-21.7; P < 0.001 and 8.3; 95% CI, 4.1-16.7; P < 0.001 for thoracic and abdominal aneurysms, respectively) and remained increased when excluding aneurysms that formed within 14 days of AD/IMH/PAU (adjusted HR, 6.2; 95% CI, 1.8-21.1; P = 0.004 and 2.8; 95% CI, 1.0-7.6; P = 0.040 for thoracic and abdominal aneurysms, respectively). CONCLUSIONS: AD/IMH/PAU patients have a substantial risk of aortic death, any aortic event, aortic intervention, and first-time diagnosis of aortic aneurysm that persists even when the acute phase (≤14 days after diagnosis) is uncomplicated. Advances in postdiagnosis treatment are necessary to improve the prognosis in these patients.


Assuntos
Aneurisma Dissecante/epidemiologia , Aneurisma Aórtico/epidemiologia , Doenças da Aorta/epidemiologia , Hematoma/epidemiologia , Úlcera/epidemiologia , Idoso , Idoso de 80 Anos ou mais , Aneurisma Dissecante/diagnóstico por imagem , Aneurisma Dissecante/mortalidade , Aneurisma Dissecante/terapia , Aneurisma Aórtico/diagnóstico por imagem , Aneurisma Aórtico/mortalidade , Aneurisma Aórtico/terapia , Doenças da Aorta/diagnóstico por imagem , Doenças da Aorta/mortalidade , Doenças da Aorta/terapia , Progressão da Doença , Feminino , Hematoma/diagnóstico por imagem , Hematoma/mortalidade , Hematoma/terapia , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Minnesota/epidemiologia , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Fatores de Tempo , Úlcera/diagnóstico por imagem , Úlcera/mortalidade , Úlcera/terapia
10.
Nat Rev Cardiol ; 17(11): 718-731, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-32518358

RESUMO

Cardiovascular disease complicates 1-4% of pregnancies - with a higher prevalence when including hypertensive disorders - and is the leading cause of maternal death. In women with known cardiovascular pathology, such as congenital heart disease, timely counselling is possible and the outcome is fairly good. By contrast, maternal mortality is high in women with acquired heart disease that presents during pregnancy (such as acute coronary syndrome or aortic dissection). Worryingly, the prevalence of acquired cardiovascular disease during pregnancy is rising as older maternal age, obesity, diabetes mellitus and hypertension become more common in the pregnant population. Management of cardiovascular disease in pregnancy is challenging owing to the unique maternal physiology, characterized by profound changes to multiple organ systems. The presence of the fetus compounds the situation because both the cardiometabolic disease and its management might adversely affect the fetus. Equally, avoiding essential treatment because of potential fetal harm risks a poor outcome for both mother and child. In this Review, we examine how the physiological adaptations during pregnancy can provoke cardiometabolic complications or exacerbate existing cardiometabolic disease and, conversely, how cardiometabolic disease can compromise the adaptations to pregnancy and their intended purpose: the development and growth of the fetus.


Assuntos
Fenômenos Fisiológicos Cardiovasculares , Diabetes Gestacional/metabolismo , Hipertensão Induzida pela Gravidez/fisiopatologia , Complicações Cardiovasculares na Gravidez/fisiopatologia , Gravidez/fisiologia , Síndrome Coronariana Aguda/diagnóstico , Síndrome Coronariana Aguda/fisiopatologia , Síndrome Coronariana Aguda/terapia , Aneurisma Dissecante/diagnóstico , Aneurisma Dissecante/fisiopatologia , Aneurisma Dissecante/terapia , Anti-Hipertensivos/uso terapêutico , Arritmias Cardíacas/diagnóstico , Arritmias Cardíacas/fisiopatologia , Arritmias Cardíacas/terapia , Aspirina/uso terapêutico , Débito Cardíaco , Cardiomiopatias/diagnóstico , Cardiomiopatias/fisiopatologia , Cardiomiopatias/terapia , Diabetes Gestacional/diagnóstico , Diabetes Gestacional/terapia , Progressão da Doença , Endocardite/diagnóstico , Endocardite/fisiopatologia , Endocardite/terapia , Feminino , Humanos , Hipertensão/fisiopatologia , Hipertensão Induzida pela Gravidez/diagnóstico , Hipertensão Induzida pela Gravidez/tratamento farmacológico , Hipoglicemiantes/uso terapêutico , Idade Materna , Obesidade Materna/metabolismo , Obesidade Materna/fisiopatologia , Inibidores da Agregação Plaquetária/uso terapêutico , Pré-Eclâmpsia/fisiopatologia , Pré-Eclâmpsia/prevenção & controle , Pré-Eclâmpsia/terapia , Gravidez/metabolismo , Complicações Cardiovasculares na Gravidez/diagnóstico , Complicações Cardiovasculares na Gravidez/terapia , Complicações Infecciosas na Gravidez/diagnóstico , Complicações Infecciosas na Gravidez/fisiopatologia , Complicações Infecciosas na Gravidez/terapia , Gravidez em Diabéticas/metabolismo , Tromboembolia Venosa/diagnóstico , Tromboembolia Venosa/tratamento farmacológico , Tromboembolia Venosa/fisiopatologia
11.
Ann Vasc Surg ; 69: 352-359, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32502679

RESUMO

BACKGROUND: Management of uncomplicated type B aortic dissection (TBAD) has traditionally been aggressive medical therapy. Recent studies brought about a paradigm shift with evidence to suggest benefits from early endovascular intervention to a high risk subgroup of acute uncomplicated TBAD patients. AIMS: We aim to review the effects of aortic remodeling in Asian patients with TBAD with and without endovascular intervention, including maximal aortic diameter, true lumen diameter, and false lumen thrombosis. METHODS: This is a single-center retrospective study of a prospective database. Patients who presented to our institution with acute TBAD from January 2008 to December 2015 (n = 44) were evaluated. Eighteen percent (8 patients) presented with complicated TBAD and underwent emergency thoracic endovascular aortic repair (TEVAR) while the remaining 82% (36 patients) were treated with optimal medical therapy (OMT). RESULTS: Six patients under the conservative arm crossed over to elective TEVAR after 6 weeks because of interval radiological progression of disease. There was no significant difference in the baseline demographics of the TEVAR group and the OMT group. At 24 months, mean maximal aortic diameter difference was -7.7 mm and +1.9 mm (P = 0.077), mean true lumen diameter difference was +10.0 mm and +2.6 mm (P = 0.049), and false lumen thrombosis was 100% and 20% (P = 0.012) for TEVAR and OMT, respectively. Kaplan-Meier analysis showed no significant difference in mortality between the 2 groups at 30 days and 2 years. CONCLUSIONS: Within an Asian population with TBAD, TEVAR with OMT has a significant positive effect on aortic remodeling, compared with OMT-only management.


Assuntos
Aneurisma Dissecante/terapia , Aorta Torácica/cirurgia , Aneurisma Aórtico/terapia , Fármacos Cardiovasculares/uso terapêutico , Procedimentos Endovasculares , Remodelação Vascular , Idoso , Aneurisma Dissecante/diagnóstico por imagem , Aneurisma Dissecante/etnologia , Aneurisma Dissecante/patologia , Aorta Torácica/diagnóstico por imagem , Aorta Torácica/patologia , Aneurisma Aórtico/diagnóstico por imagem , Aneurisma Aórtico/etnologia , Aneurisma Aórtico/patologia , Grupo com Ancestrais do Continente Asiático , Fármacos Cardiovasculares/efeitos adversos , Bases de Dados Factuais , Emergências , Procedimentos Endovasculares/efeitos adversos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Singapura , Fatores de Tempo , Resultado do Tratamento
12.
Ann Thorac Surg ; 110(5): e421-e423, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-32437675

RESUMO

A patient underwent surgery for acute type A aortic dissection. Testing for SARS-CoV-2 was positive. The postoperative course was complicated by a mixed viral and bacterial pneumonia with bilateral infiltration, treated with antibiotics and hydroxychloroquine, without any need for reintubation. The patient recovered and finally could be discharged. This report shows the feasibility for surgical treatment of acute aortic disease in patients with COVID-19.


Assuntos
Aneurisma Dissecante/etiologia , Aneurisma da Aorta Torácica/etiologia , Betacoronavirus , Tratamento Conservador/métodos , Infecções por Coronavirus/complicações , Gerenciamento Clínico , Pneumonia Viral/complicações , Doença Aguda , Aneurisma Dissecante/diagnóstico , Aneurisma Dissecante/terapia , Aneurisma da Aorta Torácica/diagnóstico , Aneurisma da Aorta Torácica/terapia , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/terapia , Humanos , Pessoa de Meia-Idade , Pandemias , Pneumonia Viral/epidemiologia , Pneumonia Viral/terapia , Tomografia Computadorizada por Raios X
13.
Vasc Endovascular Surg ; 54(6): 525-527, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32436479

RESUMO

Median arcuate ligament syndrome (MALS) is the chronic symptomatic compression of the celiac artery by the median arcuate ligament. A known potential sequela of MALS is celiac artery aneurysm, which could predispose the diseased artery to dissection. However, the presence of celiac artery dissection and MALS is yet to be reported. Here, we present a case of MALS with a coincident celiac artery aneurysm and dissection.


Assuntos
Aneurisma Dissecante/etiologia , Artéria Celíaca , Síndrome do Ligamento Arqueado Mediano/complicações , Aneurisma Dissecante/diagnóstico por imagem , Aneurisma Dissecante/terapia , Aspirina/uso terapêutico , Fármacos Cardiovasculares/uso terapêutico , Artéria Celíaca/diagnóstico por imagem , Tratamento Conservador , Feminino , Humanos , Síndrome do Ligamento Arqueado Mediano/diagnóstico por imagem , Síndrome do Ligamento Arqueado Mediano/terapia , Pessoa de Meia-Idade , Resultado do Tratamento
14.
J Cardiothorac Surg ; 15(1): 73, 2020 May 06.
Artigo em Inglês | MEDLINE | ID: mdl-32375864

RESUMO

BACKGROUND: Left atrial dissection is an extremely rare complication of mitral valve replacement. Because of its severity, its prompt diagnosis and treatment is mandatory. The most effective treatment (i.e. surgical vs. non-surgical) for left atrial dissection has not been fully established yet. CASE PRESENTATION: Herein, we have reported left atrial dissection after mitral valve replacement in a 68-year-old obese woman. After closing the thorax, transesophageal echocardiography (TEE) revealed an atrial mass of 3 cm × 2 cm, visualized as an oval hypoechoic appearance extending from the posterior annulus of the mitral valve to the posterior wall of the left atrium. Because hemodynamic conditions were stable, surgery was ruled out and conservative treatment with close observation was selected. On postoperative day 2, TEE revealed that the atrial mass had vanished and the broken piece of the endocardium merely remained fluttering in the atrium. On postoperative day 6, the appearance of the left atrium was normalized completely, leaving no traces of left atrial dissection. The patient recovered uneventfully. Serial TEE was a very effective imaging modality during the non-surgical treatment of left atrial dissection. CONCLUSIONS: It is crucial to accurately define diagnosis and optimally consider therapeutic strategies for left atrial dissection based on the hemodynamic conditions of the patient and serial TEE follow-up examinations. In our case study, left atrial dissection was successfully treated with conservative treatment; therefore, we believe that TEE could be a feasible modality for the early diagnosis of this condition.


Assuntos
Aneurisma Dissecante/diagnóstico por imagem , Endocárdio/diagnóstico por imagem , Átrios do Coração/diagnóstico por imagem , Implante de Prótese de Valva Cardíaca , Complicações Intraoperatórias/diagnóstico por imagem , Insuficiência da Valva Mitral/cirurgia , Idoso , Aneurisma Dissecante/terapia , Fibrilação Atrial/complicações , Tratamento Conservador , Ecocardiografia Transesofagiana , Feminino , Insuficiência Cardíaca/etiologia , Hemodinâmica , Humanos , Complicações Intraoperatórias/terapia , Insuficiência da Valva Mitral/complicações , Remissão Espontânea , Resultado do Tratamento
15.
BMC Cardiovasc Disord ; 20(1): 256, 2020 05 29.
Artigo em Inglês | MEDLINE | ID: mdl-32471346

RESUMO

BACKGROUND: Spontaneous isolated superior mesenteric artery dissection (SISMAD) is a rare vascular disorder, and the treatment strategies remain controversial. This study aimed to compare outcomes of conservative and endovascular treatments in symptomatic patients with SISMAD. METHODS: Forty-two consecutive SISMAD patients who were admitted to a single center between October 2009 and May 2018 were enrolled in this study. Based on their symptoms, 15 had conservative treatment, and 27 had endovascular treatment. The baseline characteristics, treatments, and follow-up results of the conservative group and endovascular group were analysed. RESULTS: The rates of symptom relief were 93.3% in the conservative group and 96.3% in the endovascular group. The procedure-related complications in the endovascular group included one case of pseudoaneurysm formation in the left brachial artery. During the follow-up period (median 28.5 months), a higher proportion of patients in the conservative group had symptom recurrence (42.9% in the conservative group versus 4.8% in the endovascular group, p < 0.001). Four patients in the conservative group and one patient in the endovascular group had additional endovascular intervention during follow-up. Compared with the conservative group, patients in the endovascular group had statistically significantly longer symptom-free survival (p = 0.014) and a higher rate of superior mesenteric artery (SMA) remodeling (p < 0.001). CONCLUSIONS: For symptomatic SISMAD, endovascularly treated patients had a lower rate of symptom recurrence and a higher rate of SMA remodeling in the long term. Prospective, multi-center studies are needed to confirm the long-term outcomes of both treatments.


Assuntos
Aneurisma Dissecante/terapia , Tratamento Conservador , Procedimentos Endovasculares , Artéria Mesentérica Superior/cirurgia , Aneurisma Dissecante/diagnóstico por imagem , Aneurisma Dissecante/fisiopatologia , Tratamento Conservador/efeitos adversos , Procedimentos Endovasculares/efeitos adversos , Feminino , Humanos , Masculino , Artéria Mesentérica Superior/diagnóstico por imagem , Artéria Mesentérica Superior/fisiopatologia , Pessoa de Meia-Idade , Recidiva , Estudos Retrospectivos , Fatores de Tempo , Resultado do Tratamento , Remodelação Vascular
16.
Ann Vasc Surg ; 68: 361-368, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32335255

RESUMO

BACKGROUND: The Investigation of Stent Grafts in Aortic Dissection with extended length of follow-up trial showed that pre-emptive thoracic endovascular aneurysm repair (TEVAR) for the uncomplicated type B dissection (TBAD) in the subacute phase promotes aortic remodeling and avoids aortic-related death 5 years after onset. However, there are some patients with complete aortic remodeling (CAR) with optimal medical treatment (OMT) and severe complications after TEVAR such as retrograde type A dissection. Therefore, which patients should undergo pre-emptive TEVAR and optimal surgical timing are still under debate. We reported that aortic wall enhancement (AWE) after endovascular aneurysm repair for abdominal aortic aneurysm was associated with sac shrinkage. However, there is no report about the relationship between AWE and aortic dissection. Herein, we evaluated the relationship between AWE and acute TBAD. METHODS: From March 2012 to May 2018, consecutive patients with acute TBAD were retrospectively collected. We retrospectively analyzed 35 patients with acute TBAD who were treated with OMT and without pre-emptive TEVAR in the subacute phase. AWE was defined as an increase of more than 20 Hounsfield units in mean computed tomography (CT) values, comparing images in delayed contrast-enhanced scans with those in plain scans evaluated within 3 months from onset. The measurement points were all slices including the wall of the false lumen. The patients with traumatic dissection, type A dissection, acute complicated type B dissection, chronic (>12 weeks) dissection, and those lost to follow-up within 3 months from onset were excluded. The primary end point was spontaneous CAR under OMT, as determined by the latest contrast-enhanced CT scan. RESULTS: The median follow-up period from onset was 86 weeks and there were 25 cases (71.4%) with AWE. Under OMT, CAR was observed in 20 patients (57.1%); this was significantly associated with abdominal branch dissection (6/15 [40%] vs. 2/20 [10%], P = 0.050), number of tears more than 2 at onset (11/15 [73%] vs. 4/20 [20%], P = 0.003), multiple tears at 1 month after onset (9/15 [60%] vs. 4/20 [20%], P = 0.020), maximal false lumen diameter at 1 month after onset (14 vs. 8 mm, P = 0.025), and AWE within 3 months of onset (7/15 [47%] vs. 18/20 [90%], P = 0.010). Multivariate analysis demonstrated a significant difference with multiple tears at onset (P = 0.014) and AWE within 3 months of onset (P = 0.047). CONCLUSIONS: AWE was associated with CAR under OMT for acute TBAD which is out of indication of pre-emptive TEVAR. Presence of AWE may be useful in predicting prognosis of TBAD.


Assuntos
Aneurisma Dissecante/terapia , Aorta Torácica/diagnóstico por imagem , Aneurisma da Aorta Torácica/terapia , Aortografia , Angiografia por Tomografia Computadorizada , Tratamento Conservador , Tomografia Computadorizada Multidetectores , Remodelação Vascular , Idoso , Idoso de 80 Anos ou mais , Aneurisma Dissecante/diagnóstico por imagem , Aneurisma Dissecante/fisiopatologia , Aorta Torácica/fisiopatologia , Aneurisma da Aorta Torácica/diagnóstico por imagem , Aneurisma da Aorta Torácica/fisiopatologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Estudos Retrospectivos , Fatores de Tempo , Resultado do Tratamento
17.
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
18.
J Clin Neurosci ; 75: 168-175, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32222429

RESUMO

BACKGROUND: Contemporary management of ruptured vertebral artery dissecting aneurysms (VADA) has evolved beyond proximal parent artery occlusion (PPAO) to include endovascular trapping (ET) of the diseased segment and vessel preserving stent treatments. The aim of this retrospective cohort study was to assess the outcomes of patients with ruptured VADAs who underwent endovascular management with trapping of the diseased segment as the first-line treatment approach. METHODS: We evaluated an institutional database of patients with ruptured VADAs who were treated at Auckland City Hospital from 1998 to 2017. Baseline and outcomes data were analyzed. High-grade SAH was defined as a World Federation of Neurological Surgeons or a Hunt and Hess grade of IV-V. Favorable outcome was defined as a modified Rankin Scale of 0-2. RESULTS: The study cohort was comprised of 45 ruptured VADA patients with a mean age of 50 years. The mean follow-up duration was 12.9 months. ET of the diseased segment was performed in 32 cases (71.1%), PPAO of the VA was performed in 12 cases (26.7%) and reconstruction using a flow diverting stent was performed in 1 case (2.2%). The overall procedural complication rate was 13%, including procedural neurological morbidity in 4.4%. At last follow-up, no further aneurysm filling was seen in any case, and 77.8% had a favorable outcome. CONCLUSION: ET affords a favorable risk to benefit profile for patients with ruptured VADAs. ET remains a reasonable option for ruptured VADAs in patients with sufficient collateral supply to the vertebrobasilar system.


Assuntos
Aneurisma Roto/terapia , Embolização Terapêutica/normas , Procedimentos Endovasculares/normas , Dissecação da Artéria Vertebral , Artéria Vertebral/patologia , Aneurisma Dissecante/terapia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Stents , Resultado do Tratamento , Dissecação da Artéria Vertebral/terapia
20.
Am J Case Rep ; 21: e921565, 2020 Feb 25.
Artigo em Inglês | MEDLINE | ID: mdl-32094319

RESUMO

BACKGROUND Cocaine abuse is a globally recognized problem with great socioeconomic and health impacts on society. We report a case of dissection of vertebral arteries and right renal artery after cocaine abuse that clinically presented as atypical headache and hypertension. CASE REPORT A 36-year-old male sought emergency care due to cervical pain after cocaine abuse. The pain was located to the right cervical side with irradiation to the homolateral temporal region. He had no previous comorbidities, except for cocaine abuse on a weekly basis. Angiotomography showed alterations compatible with recent arterial dissection of the right vertebral artery, confirmed on angioresonance. The patient received double anti-aggregation and antihypertensive drugs and was discharged. He was readmitted 5 days later due to hypertensive crisis and mild abdominal pain. Abdominal ultrasound with a Doppler of renal arteries showed signs right renal artery stenosis. Magnetic resonance angiography confirmed dissection of the same vessel. The patient underwent arteriography with stent implantation in the right renal artery. During outpatient follow-up, he progressed with gradual reduction of antihypertensive drugs. CONCLUSIONS There is only 1 case report correlating renal artery dissection with cocaine use and none with concomitant presentation of dissection in the vertebral and renal arterial beds. The scarcity of reports is a consequence of many problems. Therefore, young patients presenting with new-onset hypertension or abdominal pain and cocaine abuse history should raise suspicion for renal artery dissection.


Assuntos
Aneurisma Dissecante/induzido quimicamente , Cocaína/efeitos adversos , Hipertensão Renovascular/induzido quimicamente , Dissecação da Artéria Vertebral/induzido quimicamente , Adulto , Aneurisma Dissecante/diagnóstico por imagem , Aneurisma Dissecante/terapia , Angiografia por Tomografia Computadorizada , Humanos , Hipertensão Renovascular/diagnóstico por imagem , Hipertensão Renovascular/terapia , Angiografia por Ressonância Magnética , Masculino , Artéria Renal/diagnóstico por imagem , Stents Metálicos Autoexpansíveis , Dissecação da Artéria Vertebral/diagnóstico por imagem , Dissecação da Artéria Vertebral/terapia
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