Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 631
Filtrar
1.
Angiol Sosud Khir ; 25(3): 101-106, 2019.
Artigo em Russo | MEDLINE | ID: mdl-31503253

RESUMO

The study was aimed at analysing the immediate results of various surgical approaches to prosthetic repair of ascending aortic aneurysms. We analysed the data of 113 patients operated on for an ascending aortic aneurysm from 2008 to 2017. All patients were divided into two comparable groups. Group One patients (n=43) underwent prosthetic repair of the ascending portion of the aorta with formation of a distal anastomosis proximal to the level of the brachiocephalic trunk, Group Two patients (n=70) were subjected to reconstruction of the ascending aorta with aortic arch plasty ('hemiarch'). In the early postoperative period in Group One and Group Two patients, the frequency of adverse cardiac events amounted to 3 (7.0%) and 1 (1.5%) cases (p=0.339), with prolonged mechanical ventilation required in 12 (18.6%) and 6 (8.6%) cases and resternotomy required in 8 (18.6%) and 4 (5.7%) cases, respectively. The postoperative 30-day mortality in the group of isolated prosthetic repair of the ascending aorta amounted to 11.6% (5 cases) and in the group of patients with the hemiarch reconstruction to 3.0% (2 cases). No neurological complications were observed. Hemiarch prosthetic repair of the aorta is an effective and safe surgical method of treatment. This approach does not increase the risks for cardiac, neurological, pulmonary, haemorrhagic complications in the immediate postoperative period as compared with prosthetic repair of only the ascending portion of the aorta.


Assuntos
Aneurisma da Aorta Torácica , Aneurisma Aórtico , Implante de Prótese Vascular , Aorta Torácica , Aneurisma da Aorta Torácica/terapia , Humanos , Complicações Pós-Operatórias , Estudos Retrospectivos
2.
Angiol Sosud Khir ; 25(3): 163-166, 2019.
Artigo em Russo | MEDLINE | ID: mdl-31503261

RESUMO

Treatment of patients presenting with type I aortic dissection is known to be a surgical challenge. The Djumbodis bare metal stent was developed to ease the burden of a reconstructive intervention on the aortic arch, to decrease the duration of the operation, and to minimize complications associated with artificial circulation. Currently, insufficiently explored remains the problem of complications occurring due to the technological fatigue of the metal and possible stent migration. Described herein is a clinical case report regarding migration of a Djumbodis stent, diagnosed 6 months after implantation for DeBakey type I acute aortic dissection. We revealed dislocation of the stent's distal portion with fenestration of the membrane of the true channel and perfusion of the false channel, as well as fractured fragments of the stent. The patient underwent repeat 'open' intervention.


Assuntos
Aneurisma Dissecante , Aneurisma da Aorta Torácica , Implante de Prótese Vascular , Migração de Corpo Estranho , Aneurisma da Aorta Torácica/terapia , Humanos , Stents , Resultado do Tratamento
3.
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
4.
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
5.
Braz J Cardiovasc Surg ; 34(4): 472-479, 2019 08 27.
Artigo em Inglês | MEDLINE | ID: mdl-31454202

RESUMO

The roles that aortitis plays in the development of annuloaortic ectasia (AAE) remain uncertain, while clinical features of AAE in arteritis are largely unknown. This study was designed to highlight the clinical features of AAE, the treatments of choice, and the causative relations between aortitis and AAE. The morphology of the aortic valve leaflets was normal in half of the patients, while the valves were thin and overstretched in the other half. Most patients had an aortic aneurysm. Half of the patients had severe aortic valve insufficiency, and one-quarter of them had dilation of the sinuses of Valsalva. Takayasu arteritis was prone to develop coronary artery lesions, whereas giant cell arteritis were not. Aortic branch lesions in Takayasu arteritis were stenotic or occlusive in 92.9% of the patients, while in giant cell arteritis, they were all dilated lesions. Most patients (94.7%) required surgical treatment with steroid therapy. However, long-term follow-up results showed a higher anastomotic dehiscence rate, particularly in patients with Takayasu arteritis. Further morphometric and pathological research on AAE in arteritis should be undertaken, and more feasible measures should be warranted for preventing postoperative anastomotic dehiscence.


Assuntos
Aneurisma da Aorta Torácica/terapia , Arterite de Células Gigantes/terapia , Arterite de Takayasu/terapia , Aneurisma da Aorta Torácica/complicações , Aneurisma da Aorta Torácica/cirurgia , Arterite de Células Gigantes/complicações , Arterite de Células Gigantes/cirurgia , Humanos , Complicações Pós-Operatórias , Arterite de Takayasu/complicações , Arterite de Takayasu/cirurgia
6.
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
7.
Cardiovasc Intervent Radiol ; 42(10): 1500-1504, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31338553

RESUMO

Ascending aortic pseudoaneurysms are a rare but potentially life-threatening complication of aortic root or cardiac surgery. Surgical repair is established as first-line treatment; however, patient comorbidities, technical considerations, and anatomic limitations often preclude patients from repeat surgery, thus necessitating alternative approaches. Here, we present a case of coil embolization of an ascending aortic pseudoaneurysm via a transapical approach in a particularly complex scenario where percutaneous and peripheral access was technically unfeasible.


Assuntos
Falso Aneurisma/terapia , Aneurisma da Aorta Torácica/terapia , Embolização Terapêutica/métodos , Complicações Pós-Operatórias/terapia , Falso Aneurisma/diagnóstico por imagem , Aorta Torácica/diagnóstico por imagem , Aneurisma da Aorta Torácica/diagnóstico por imagem , Procedimentos Cirúrgicos Cardíacos , Angiografia por Tomografia Computadorizada , Evolução Fatal , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/diagnóstico por imagem
8.
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
9.
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
10.
BMC Med Imaging ; 19(1): 31, 2019 04 27.
Artigo em Inglês | MEDLINE | ID: mdl-31029094

RESUMO

BACKGROUND: A pseudoaneurysm occurs as the result of a contained rupture of an arterial wall, yielding a perfused sac that communicates with the arterial lumen. Pseudoaneurysm of an intercostal artery is an extremely rare event but it carries with it a significant risk of rupture and subsequent hemothorax. It must be considered as a potential complication of thoracentesis. CASE PRESENTATION: Here, we report a rare case of an intercostal artery pseudoaneurysm following thoracentesis in an 82-year old male. The patient presented with respiratory distress 1 day after a therapeutic thoracentesis had been performed. Computed tomography (CT) with contrast revealed a left intercostal pseudoaneurysm with hemothorax and adjacent compressive atelectasis. Doppler ultrasound revealed bidirectional blood flow in the pseudoaneurysm sac. An intercostal arteriogram and thoracic aortogram aided in confirmation of the pseudoaneurysm and successful treatment with coil embolization. CONCLUSIONS: An intercostal pseudoaneurysm complication following thoracentesis is very rare but important to rule out as a possible cause of hemothorax after the procedure. Capturing this finding with the aid of multiple imaging modalities allowed for diagnostic certainty and rapid treatment with coil embolization, leading to a successful patient recovery.


Assuntos
Falso Aneurisma/diagnóstico por imagem , Aneurisma da Aorta Torácica/diagnóstico por imagem , Hemotórax/diagnóstico por imagem , Toracentese/efeitos adversos , Idoso de 80 Anos ou mais , Falso Aneurisma/etiologia , Falso Aneurisma/terapia , Angiografia , Aneurisma da Aorta Torácica/etiologia , Aneurisma da Aorta Torácica/terapia , Aortografia , Meios de Contraste/administração & dosagem , Embolização Terapêutica , Hemotórax/etiologia , Hemotórax/terapia , Humanos , Masculino , Imagem Multimodal , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Ultrassonografia Doppler
11.
Angiol Sosud Khir ; 25(1): 115-119, 2019.
Artigo em Russo | MEDLINE | ID: mdl-30994617

RESUMO

Contemporary approaches to treatment of patients with dissection of the descending aorta (DA), as well as the data of international registries and guidelines are contradictory. The endovascular method of treatment of patients with descending aortic dissection has been recognized to be revolutionary. However, there seems to be no commonly accepted concept concerning appropriate use of currently available techniques of treating patients with DA dissection. This study was aimed at analysing the experience gained in using various methods of treatment of patients with descending aortic dissection (DAD). We retrospectively examined the results of surgical treatment of 78 patients with DAD. Of these, 45 patients were found to have Stanford type B dissection and 33 patients had type A dissection, who underwent treatment during ten years from January 2008. The decision concerning the type of care for patients with DAD (conservative, surgical, endovascular or combined methods of treatment) directly depends on the patient's state stability, technical feasibility of the intended procedure, and the presence of concomitant pathology. The findings obtained in our study demonstrated better immediate outcomes of the endovascular approach compared with the hybrid and surgical ones. In order to achieve complete haemodynamic correction of the pathology, to minimize the risk of aortic remodelling and the development of aorta-related complications, the treatment should not be limited to endoprosthetic repair of the thoracic portion of the DA with a stent graft, but should rather be supplemented with stenting of more distal segments, including with uncoated stents at the level of the visceral branches. Only such staged approach may provide better conditions for obliteration of the aortic false lumen and formation of a 'neo-frame' of the aortic wall.


Assuntos
Aneurisma Dissecante , Aneurisma da Aorta Torácica , Implante de Prótese Vascular , Procedimentos Endovasculares , Aneurisma Dissecante/terapia , Aneurisma da Aorta Torácica/terapia , Humanos , Complicações Pós-Operatórias , Estudos Retrospectivos , Stents , Resultado do Tratamento
12.
Angiol Sosud Khir ; 25(1): 164-167, 2019.
Artigo em Russo | MEDLINE | ID: mdl-30994623

RESUMO

Presented in the article is a clinical case report regarding hybrid surgical management of a saccular aneurysm of the aortic arch: simultaneous right-left-carotid-left-subclavian bypass grafting and endovascular isolation of the aneurysm. Taking into consideration the findings of multislice computed tomography-aortography (MSCT aortography) prior to surgery, the anatomical location of the aneurysm with the involvement of the ostium of the left subclavian artery, close location of the proximal branches of the aortic arch at an acute angle relative to each other required performing simultaneous debranching in order to enlarge the proximal zone of fixation of a stent graft at the level of the brachiocephalic trunk (BCT). The postoperative period proved uneventful, with as rapid rehabilitation as possible. From our own experience, with this one being not the first similar operation performed in the Centre, it may be supposed that carrying out simultaneous hybrid interventions in treatment of aneurysms of the aortic arch with the use of different variants of switching its branches may decrease the frequency of postoperative complications for patients of high surgical risk, reduce the length of hospital stay and, consequently, economic expenditures for treatment.


Assuntos
Aneurisma da Aorta Torácica , Implante de Prótese Vascular , Procedimentos Endovasculares , Aorta Torácica , Aneurisma da Aorta Torácica/terapia , Aortografia , Prótese Vascular , Humanos , Stents , Artéria Subclávia , Resultado do Tratamento
13.
J Vasc Surg ; 70(3): 718-723, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-30871887

RESUMO

OBJECTIVE: The c.530G>A (p.Arg177Gln) mutation in PRKG1 has been shown to be associated with thoracic aortic aneurysms and dissections. This rare mutation accounts for an estimated 1% of nonsyndromic heritable thoracic aortic disease. We sought to describe the clinical presentation of type B aortic dissection (TBAD), management, and outcomes in patients with this mutation. METHODS: This is a descriptive multi-institutional retrospective study of patients from six families with the PRKG1 mutation. Patients with TBAD were selected for analysis. Demographics, family histories, TBAD management, and outcomes were reviewed. RESULTS: Of the 29 individuals diagnosed with the PRKG1 mutation, 12 (41.3%) had TBAD (50% male, TBAD median age: 31 years [range, 16-58 years], median follow-up: 6 years [range, 3-15 years] after TBAD). All had a family history of aortic dissections and none had features of Marfan syndrome. The median size of the descending thoracic aorta (DTA) at TBAD was 4.1 cm (range, 3.8-5 cm). Most cases (9 acute TBAD, 1 incidental TBAD diagnosis during screening) were managed medically. One case had open DTA repair the acute phase. Repair for dissection-related aneurysmal degeneration was performed in seven cases (58.3%) in the chronic phase at a median of 2 years (range, 1-8 years) after TBAD. In four cases (33.3%), the DTA remained stable in size over a range of 1 to 7 years after TBAD. Type A aortic dissection subsequent to TBAD occurred in three cases (25%). There were four (33.3%) deaths in the series, all aortic related at a median age of 24 years (range, 19-43 years). CONCLUSIONS: The PRKG1 (p.Arg177Gln) mutation although rare is associated with nonsyndromic TBAD in young and middle-aged patients. Workup for this gene mutation should be included as part of the workup for TBAD etiology in relatively young patients and those with familial history of aortic dissections. Once diagnosed, testing of first-degree family members is warranted. In all individuals with a PRKG1 mutation, close follow-up for aortic root dilatation and hypertension control is essential to reduce the risk of type A or type B aortic dissection, and in cases of TBAD, to decrease the risk of dissection-related aneurysmal degeneration.


Assuntos
Aneurisma Dissecante/genética , Aneurisma da Aorta Torácica/genética , Proteína Quinase Dependente de GMP Cíclico Tipo I/genética , Mutação , Adolescente , Adulto , Aneurisma Dissecante/diagnóstico por imagem , Aneurisma Dissecante/enzimologia , Aneurisma Dissecante/terapia , Aneurisma da Aorta Torácica/diagnóstico por imagem , Aneurisma da Aorta Torácica/enzimologia , Aneurisma da Aorta Torácica/terapia , Feminino , Predisposição Genética para Doença , Hereditariedade , Humanos , Masculino , Pessoa de Meia-Idade , Linhagem , Fenótipo , Prognóstico , Estudos Retrospectivos , Fatores de Risco , Estados Unidos , Adulto Jovem
14.
J Cardiothorac Surg ; 14(1): 44, 2019 Feb 26.
Artigo em Inglês | MEDLINE | ID: mdl-30845982

RESUMO

BACKGROUND: Preemptive thoracic endovascular aortic repair (TEVAR) is an advanced treatment that has possibility to improve late outcomes in patients with subacute type B aortic dissection. However, it may not be the treatment of choice for elderly patients with uncomplicated subacute type B aortic dissection because of their inherent frailty and increased risk of periprocedural complications. METHODS: Data were collected between July 2004 and October 2017 in Yamagata university hospital and between February 2016 and May 2018 in Nihonkai General hospital. A total of 152 medically treated subacute type B aortic dissection patients were enrolled in this study. Patients were divided into two groups: age 80 year and older group (Group O, n = 33, 22%) and a group < 80 years of age (Group U, n = 119, 78%). RESULTS: During follow-up, the incidence of adverse events was 27% (n = 9) in Group O and 37% (n = 44) in Group U (P = 0.409). The incidence of aortic rupture was 3% (n = 1), and the incidence of acute type A dissection was 3% (n = 1) in Group O. In Group O, only one patient (3%) died of aorto-bronchial fistula. The Group O patients had less surgical intervention (3 patients [9%] in Group O and 30 patients [25%] in Group U, P = 0.047), but aortic related death did not differ between the two groups. The 1-, 2-, and 5-year freedom from aorta-related death rates of Group O were 97, 97, and 97%, respectively, compared with 99, 94, and 91%, respectively, in Group U (P = 0.880). CONCLUSIONS: Patients aged 80 years and older who underwent medical treatment for acute and subacute type B dissection had excellent outcomes in chronic phase. The elderly patients had less surgical intervention, but aortic related death did not differ from younger patients.


Assuntos
Aneurisma Dissecante/cirurgia , Aneurisma da Aorta Torácica/cirurgia , Idoso , Idoso de 80 Anos ou mais , Aneurisma Dissecante/terapia , Aneurisma da Aorta Torácica/terapia , Implante de Prótese Vascular/efeitos adversos , Procedimentos Endovasculares/efeitos adversos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento
15.
J Vasc Surg ; 70(3): 710-717, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-30850289

RESUMO

OBJECTIVE: Failure of thoracic endovascular aortic repair (TEVAR) in chronic aortic dissections can be partially explained by retrograde false lumen (FL) flow through distal re-entry tears. After implantation of a thoracic stent graft, FL thrombosis occurs in less than 50% of the cases. The objectives of this study were to describe the feasibility and outcomes of FL embolization in patients with chronic aortic dissections. METHODS: Between June 2015 and January 2018, 27 patients (mean age, 61 ± 14 years) with chronic aortic dissection underwent FL embolization as an adjunct during or after TEVAR placement procedure. Indications for embolization were (1) symptomatic chronic aortic dissections with pain or rapid growth of aortic diameter (≥5 mm/y) requiring rapid exclusion of the aneurysm, (2) aneurysmal dilatation with persistent FL retrograde flow after TEVAR, and (3) large FL aneurysms (≥55 mm) that might lead to persistent retrograde flow. Twenty patients presented with type B chronic aortic dissections (74.1%) and seven presented a residual type A chronic aortic dissections (25.9%). Eight patients had a previous aortic arch replacement (29.6%). Six patients had previous repair with TEVAR (22.2%). The delay between the onset of dissection and the first endovascular repair was 47 months (range, 3-144). Spinal fluid drainage was used in 74.1% of cases (20/27 patients). Embolization devices included coils and vascular plugs. RESULTS: The technical success rate was 100% (27/27). Complete spinal cord ischemia was observed in one patient (3.7%). There was one hospital death from pneumonia after zone 1 supra-aortic trunk debranching with TEVAR and embolization. After the index procedure, FL thrombosis was observed in 81.5% of patients (22/27) on late phase computed tomography angiography. Five patients required two or more embolization procedures, leading to a high rate of complete FL thrombosis (92.6%). One patient presented a type IB endoleak and one patient presented a type II endoleak. Radiologic follow-up was 20 ± 10 months. The maximum thoracic aortic diameter significantly decreased from 63 mm to 54 ± 10 mm (P < .001). CONCLUSIONS: Embolization of the FL of chronic aortic dissections is technically feasible with a low morbidity rate. The FL thrombosis is observed in the majority of case and promotes favorable thoracic aortic remodeling. Longer follow-up is needed to confirm these good results on the thoracic aorta and this technique may, therefore, improve the results of TEVAR in chronic aortic dissections.


Assuntos
Aneurisma Dissecante/terapia , Aorta Torácica/cirurgia , Aneurisma da Aorta Torácica/terapia , Implante de Prótese Vascular , Embolização Terapêutica , Procedimentos Endovasculares , Remodelação Vascular , Idoso , Aneurisma Dissecante/diagnóstico por imagem , Aneurisma Dissecante/fisiopatologia , Aorta Torácica/diagnóstico por imagem , Aorta Torácica/fisiopatologia , Aneurisma da Aorta Torácica/diagnóstico por imagem , Aneurisma da Aorta Torácica/fisiopatologia , Implante de Prótese Vascular/efeitos adversos , Bases de Dados Factuais , Embolização Terapêutica/efeitos adversos , Endoleak/etiologia , Procedimentos Endovasculares/efeitos adversos , Estudos de Viabilidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Sistema de Registros , Estudos Retrospectivos , Fatores de Risco , Isquemia do Cordão Espinal/etiologia , Fatores de Tempo , Resultado do Tratamento
16.
Medicine (Baltimore) ; 98(6): e14330, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30732155

RESUMO

INTRODUCTION: Treatment of infection aortic pseudoaneurysm (PSA) is a great challenge to surgeons for 3 reasons: high mortality for rupture or threatened rupture; potential risk for infection of prosthetic material which probably bring a devastating result for patients; and long-term antibiotic therapy requirement. Endovascular repair is an alternative to open surgery for a less invasive, which is a trouble procedure for aortic PSA with complex aortic anatomy. The purpose of this article is to report the novel hybrid repair of an infection aortic PSA and antibiotics therapy. CLINICAL FINDING: A 61-year-old man with complaints of repeated abdominal pain and fever for 3 months was admitted. He had a fever of 39.0°C and normal blood pressure. The blood leukocyte count was 14.9 × 10/L, C-reactive protein was 132 mg/L. There was no evidence for urinary tract infection. The small effusion was identified in bilateral thoracic cavity and pelvis cavity, and the severe lung function impairment was detected. Klebsiella pneumoniae was identified in blood cultures. Computer tomographic (CT) angiography showed a 6 cm × 6 cm aortic PSA involving bilateral renal arteries and a subhepatic inflammatory mass (identified by percutaneous puncture). DIAGNOSIS: According to the symptoms, CT and lab test, the main diagnosis for this patient were: infective aortic PSA involving bilateral renal arteries, and Bacteremia with K pneumoniae. INTERVENTION AND OUTCOMES: A hybrid procedure combined open surgical and endovascular was performed for managing the paravisceral infection aortic PSA in a 61-year-old man with high risk. To decrease the risk of graft infection, autologous saphenous vein graft was adopted, and long-term antibiotic therapy was used. At 2 years follow-up, the patient was in good clinical condition with continued antibiotic therapy. CONCLUSION: Hybrid procedure is an alternative approach according to high risk patients with complex anatomy for open repair of infection aortic PSA. The postoperative long-time continued antibiotic therapy must be emphasized for infection PSA.


Assuntos
Falso Aneurisma/terapia , Antibacterianos/uso terapêutico , Aneurisma da Aorta Torácica/terapia , Implante de Prótese Vascular , Falso Aneurisma/diagnóstico , Aneurisma da Aorta Torácica/diagnóstico , Humanos , Masculino , Pessoa de Meia-Idade
17.
Ann Vasc Surg ; 57: 60-68, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30684608

RESUMO

BACKGROUND: The natural history of the thoracic false lumen after coil embolization for type B aortic dissection (TBAD) treated by previous thoracic endovascular aortic repair (TEVAR) remains a matter of debate. The aim of this study is to assess the efficacy of coil embolization in promoting thoracic aortic remodeling of TBAD with persistent thoracic false lumen after TEVAR. METHODS: Between January 2015 and December 2016, 7 consecutive TBAD patients with persistent thoracic false lumen post-TEVAR underwent coil embolization, either isolated (3 with maximum thoracic aortic diameter <55 mm) or combined with adjunctive procedure(s) specifically for distal re-entry tears (4 with thoracic aneurysmal aortic dissection ≥55 mm in diameter). Pre- and postcoiling computer tomography angiography (CTA) images were used to evaluate aortic remodeling via false lumen thrombosis status and maximum thoracic aorta diameter. RESULTS: Procedures were performed successfully in all patients, without intraoperative complications or 30-day mortality. Two dissection-related deaths occurred after hospital discharge, yielding a 6-month mortality of 28.6%. Six patients had surveillance CTA images available for analyses at median 11.2 months (range 5.6-23.5) of follow-up. Thoracic aortic shrinkage and completely thrombosed thoracic false lumen were seen in 1 patient (16.7%); thoracic aortic stabilization albeit with persistent blood flow along the false lumen below or even more proximal to the embolization in 4 patients (66.7%); and continued thoracic aortic growth and aortoesophageal fistula proximal to the embolized false lumen in 1 patient. CONCLUSIONS: In this retrospective single center experience, the efficacy of coil embolization in promoting thoracic aortic remodeling of TBAD with persistent thoracic false lumen post-TEVAR appears to be limited, especially in patients with thoracic aneurysmal aortic dissection. Further studies are warranted to inform the optimal treatment strategy.


Assuntos
Aneurisma Dissecante/terapia , Aneurisma da Aorta Torácica/terapia , Implante de Prótese Vascular , Embolização Terapêutica/instrumentação , Procedimentos Endovasculares , Adulto , Idoso , Aneurisma Dissecante/diagnóstico por imagem , Aneurisma Dissecante/fisiopatologia , Aneurisma Dissecante/cirurgia , Aneurisma da Aorta Torácica/diagnóstico por imagem , Aneurisma da Aorta Torácica/fisiopatologia , Aneurisma da Aorta Torácica/cirurgia , Aortografia/métodos , Prótese Vascular , Implante de Prótese Vascular/efeitos adversos , Implante de Prótese Vascular/instrumentação , Angiografia por Tomografia Computadorizada , Embolização Terapêutica/efeitos adversos , Procedimentos Endovasculares/efeitos adversos , Procedimentos Endovasculares/instrumentação , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Stents , Fatores de Tempo , Resultado do Tratamento , Remodelação Vascular
18.
Arterioscler Thromb Vasc Biol ; 39(2): 126-136, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30651002

RESUMO

Thoracic aortic aneurysms that progress to acute aortic dissections are often fatal. Thoracic aneurysms have been managed with treatment with ß-adrenergic blocking agents (ß-blockers) and routine surveillance imaging, followed by surgical repair of the aneurysm when the risk of dissection exceeds the risk for repair. Thus, there is a window to initiate therapies to slow aortic enlargement and delay or ideally negate the need for surgical repair of the aneurysm to prevent a dissection. Mouse models of Marfan syndrome-a monogenic disorder predisposing to thoracic aortic disease-have been used extensively to identify such therapies. The initial finding that TGFß (transformation growth factor-ß) signaling was increased in the aortic media of a Marfan syndrome mouse model and that its inhibition via TGFß neutralization or At1r (Ang II [angiotensin II] type I receptor) antagonism prevented aneurysm development was generally viewed as a groundbreaking discovery that could be translated into the first cure of thoracic aortic disease. However, several large randomized trials of pediatric and adult patients with Marfan syndrome have subsequently yielded no evidence that At1r antagonism by losartan slows aortic enlargement more effectively than conventional treatment with ß-blockers. Subsequent studies in mouse models have begun to resolve the complex molecular pathophysiology underlying onset and progression of aortic disease and have emphasized the need to preserve TGFß signaling to prevent aneurysm formation. This review describes critical experiments that have influenced the evolution of our understanding of thoracic aortic disease, in addition to discussing old controversies and identifying new therapeutic opportunities.


Assuntos
Aneurisma Dissecante/terapia , Aneurisma da Aorta Torácica/terapia , Doença Aguda , Angiotensina II/fisiologia , Animais , Aneurisma da Aorta Torácica/etiologia , Humanos , Losartan/uso terapêutico , Camundongos , Transdução de Sinais/fisiologia , Fator de Crescimento Transformador beta/fisiologia
19.
Gen Thorac Cardiovasc Surg ; 67(1): 1-11, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-29204794

RESUMO

Thoracic aortic aneurysm (TAA) is an increasingly recognized condition that is often diagnosed incidentally. This review discusses ten of the most relevant epidemiological and clinical secrets of this disease; (1) the difference in pathogenesis between ascending and descending TAAs. TAAs at these two sites act as different diseases, which is related to the different embryologic origins of the ascending and descending aorta. (2) The familial pattern and genetics of thoracic aneurysms. Syndromic TAAs only explain 5% of the pattern of inheritance. (3) The effect of female sex on TAA growth and outcome. Females have been found to have worse outcomes compared to males. (4) Guilt by Association. TAAs are associated with abdominal aortic aneurysms, intracranial aneurysms, bicuspid aortic valve, and inflammatory disorders. (5) Natural history of TAAs. Important findings have been made regarding the expansion rate (in relation to familial pattern, location and size), and also regarding the risk of rupture or dissection. (6) The aortic size paradox. Size only is not a sufficient predictor of risk of dissection. (7) Biomarker void. Although many serum biomarkers have been studied, imaging remains the only reliable method for diagnosis and follow-up. (8) Indications for repair. Decisions are made depending on symptoms, location, size, and familial patterns. (9) Types of repair. Both open and endovascular repair options are available for certain TAAs. (10) Medical treatment. The efficacy of prescribing beta blockers, angiotensin converting enzyme inhibitors or angiotensin receptor blockers remains dubious.


Assuntos
Aneurisma Dissecante/diagnóstico , Aorta Torácica/diagnóstico por imagem , Aneurisma da Aorta Torácica/diagnóstico , Diagnóstico por Imagem , Gerenciamento Clínico , Aneurisma Dissecante/terapia , Aneurisma da Aorta Torácica/terapia , Humanos
20.
World J Surg ; 43(1): 273-281, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30128772

RESUMO

BACKGROUND: Surgical decision making remains difficult in several patients with aneurysmal disease of the descending thoracic (DT) or thoracoabdominal (TA) aorta. Despite previous studies that have investigated aneurysms treated non-operatively using a prospective growth analysis, completeness and accuracy of follow-up were inconsistent. We aim to describe the survival and freedom from adverse aortic events in patients with DT and TA who did not undergo operative repair. METHODS: This is a single-center retrospective analysis of all patients with either a descending degenerative atherosclerotic or dissection-related DT or TA aortic lesion who were treated non-operatively from April 2002 to December 2016. We studied patients who did not undergo operative repair of descending degenerative atherosclerotic or dissection-related DT or TA aortic lesion. Primary end points were overall survival and freedom from aortic-related mortality (ARM). RESULTS: Of the 315 patients diagnosed with DT or TA disease, 56 (18%) did not undergo surgical repair. Mean aneurysm diameter was 65 mm ± 15 (range 50-120; IQR 5.4-7.15). Extent of the aortic aneurysms was DT in 36 (11%) patients and TA in 20 (6%). Median duration of follow-up was 12 months (range 1-108; IQR 3-36). Over the course of the study, 41 (73%) patients died for an overall survival rate of 53% ± 7 at 1 year (95% CI 40-65) and 23% ± 7 at 3 year (95% CI 17-42.5). Aortic-related mortality was 27% (n = 15), significantly higher in patients with aneurysms ≥ 60 mm [n = 13, (39%) vs. n = 2, (9%); P = 0.025; OR = 5.04]. Overall, estimated freedom from ARM was 81% ± 5.5 at 1 year (95% CI 68-89) and 66.5% ± 9 at 3 year (95% CI 48-81). Only TA extent was independently associated with freedom from ARM during the follow-up (P = 0.005; HR: 5.74; 95% CI 1.711-19.729). CONCLUSIONS: Thoracoabdominal extent of the aneurysmal aortic disease is the most important predictor of ARM in unrepaired DT or TA aortic diseases. Mortality from aortic-related events was significantly more premature than mortality from non-aortic-related mortality.


Assuntos
Aneurisma da Aorta Torácica/mortalidade , Aneurisma da Aorta Torácica/terapia , Idoso , Idoso de 80 Anos ou mais , Aneurisma Dissecante/mortalidade , Aneurisma Dissecante/terapia , Aterosclerose/complicações , Comorbidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA