Advances in the diagnosis of acute aortic syndromes: Role of imaging techniques

Ciccone, Marco Matteo; Dentamaro, Ilaria; Masi, Francesco; Carbonara, Santa; Ricci, Gabriella

doi:10.1177/1358863x16631419

Cited by 22 publications

(25 citation statements)

References 69 publications

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“…This condition in particular may be associated with a specific strength of IVUS-pitfalls in CT angiography may result in difficulties in distinguishing aortic borders, TL, and FL [ 11 ]. IVUS offers valuable information regarding the underlying aortic disease with precise localization of significant pathologies in real-time, and therefore may have an important impact on treatment in these specific circumstances [ 12 , 13 ]. Moreover, IVUS assistance is of an additional value in patients with impending or already existing aortic rupture, especially after blunt trauma where the accurate estimation of the vessel diameter at the time of CT is difficult due to poor volume filling.…”

Section: Discussionmentioning

confidence: 99%

Intravascular ultrasound assisted sizing in thoracic endovascular aortic repair improves aortic remodeling in Type B aortic dissection

et al. 2018

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The precise sizing of the stent graft in thoracic endovascular aortic repair (TEVAR) affects aortic remodeling and hence, further outcome. Covering the proximal entry tear is essential for successful treatment of Type B aortic dissection. Intravascular ultrasound (IVUS) enables real-time aortic diameter assessment, and is especially useful when computed tomography (CT) image quality is poor. IVUS, however, is not routinely utilized due to cost inefficiency. We investigated the impact of IVUS-assisted stent graft sizing on aortic remodeling in TEVAR. In this single-center retrospective study we evaluated patients with Type B aortic dissection undergoing both CT and IVUS before TEVAR. We assessed the aortic diameter at the level of the left subclavian artery via both methods before stent implantation and analyzed due to which method the implanted stent graft was chosen, retrospectively. To determine the degrees of aortic remodeling involved, we evaluated true lumen and false lumen diameters, and total aortic remodeling in CT. We analyzed 45 patients with Type B aortic dissection undergoing TEVAR. The mean ages were 66.9±10.0 years fo0072 IVUS (n = 20) and 62.3±14.2 years for CT-assisted TEVAR (n = 25; p = 0.226). The follow-up time for both groups did not differ between the two groups (IVUS: 22.9±23.1 months, CT: 25.6±23.0 months; p = 0.700). While both methods were associated with advantages regarding aortic remodeling, IVUS-assisted sizing yielded a greater increase in true lumen (30.4±6.2 vs. 25.6±5.3; p = 0.008) and reductions in false lumen (14.4±8.5 vs. 23.9±9.3; p = 0.001) and total aortic diameter (35.5±6.0 vs. 39.9±8.1; p = 0.045). IVUS-guided stent graft sizing in Type B aortic dissection shows beneficial effects on aortic remodeling and might be of additional advantage in aortic diseases, especially when CT image quality is poor.

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Section: Discussionmentioning

confidence: 99%

Intravascular ultrasound assisted sizing in thoracic endovascular aortic repair improves aortic remodeling in Type B aortic dissection

et al. 2018

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“…[15][16][17] At the time of presentation, our patient's known risk for AD was hypertension, which is a predisposing condition in 50%-70% of patients with aortic dissection. [16][17][18] His PCP use also raised concern for a vascular catastrophe. Family history was later discovered to be signifi cant with aortic aneurysm in his father and two brothers.…”

Section: Discussionmentioning

confidence: 99%

“…[15] CTA (multidetector computed tomography with arterial contrast), magnetic resonance imaging (MRI), and TEE offer comparable sensitivities and specificities for the diagnosis of aortic dissection. [15,[18][19][20][21] Imaging modality is chosen based on the individual patient and institutional capabilities, with CTA as the recommended initial imaging choice in the ED [16,18,22] due to its availability, rapid imaging of the entire aorta, and ability to detect alternative diagnoses. Diagnostic features of AD on CTA include intimal flap (a lucent strip or displacement of intimal calcifi cation), double lumen (true and false), and dilation of the aorta (aneurysm).…”

Section: Discussionmentioning

confidence: 99%

Computed tomography angiography-negative aortic dissection in a patient using Phencyclidine

DeWeert

Lovell

Patel

2018

World Journal of Emergency Medicine

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Although the average age of diagnosis for aortic dissection is 63, [1] this case demonstrates the need to consider AD in younger patients, particularly in the presence of risk factors or in the absence of another reasonable diagnosis. This case suggests PCP use as a precipitant for hypertension and sympathomimetic stress on the aorta. Despite high sensitivity, false negative CTA imaging for AD can occur. If pretest probability remains high, further imaging must be obtained. During resuscitation in the ED, focused point-of-care ultrasound can also assist with medical decision making. Funding: None. Ethical approval: Not needed. Conflicts of interest: The authors declare that no competing interest and no personal relationships with other people or organizations that could inappropriately infl uence their work. Contributors: DD proposed the study and wrote the fi rst draft. All authors read and approved the fi nal version of the paper.

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“…In recent years, the physicians raise awareness and understanding of aortic dissection. Computed tomography angiography (CTA) imaging technology and magnetic resonance imaging (MRI) continue to improve greatly in the clinical setting [2,3] . Many patients could be timely diagnosed and accept the individualized treatment programs.…”

Section: Introductionmentioning

confidence: 99%

Treatment of Acute Aortic Dissections: A Single Centre Experience

Pan¹,

Zhang²,

Qian³

et al. 2016

SJAMS

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The objective is to summarize initial experience in the management of acute aortic dissections. From January 2010 to July 2014, we had Debakey I aortic dissection 17 (39.5), Debakey II 4 (9.3%) and Debakey III 22(51.2%). Surgery was performed in 10 patients. Thoracic endovascular repair was performed in 15 patients. The other 10 patients received medical therapy. Aortic remodeling was evaluated comparing preoperative and most recent computed tomography scans during their follow up. In surgical treatment of 10 cases, the mean cardiopulmonary bypass time was 203.50 ± 109.64 min, mean myocardial ischemia time was 82.20 ± 49.68 min, and mean time of selective cerebral perfusion at 25°C was 36.24 ± 15.48 min. Main complications were bleeding (10%), low cardiac output syndrome(10%), stroke (10%), prolonged mechanical ventilation (20%) and acute renal failure (20%). In-hospital mortality of 10.0%. There was no need for second-stage operation. Thoracic endovascular repair was successfully performed in 10 cases. False-lumen thrombosis was obtained in 80%. Follow up duration ranged from 20-60 months. There was no death, reoperation or no rupture during the follow up. Timely and accurate diagnosis in early stage and individualized treatment can improve the survival of aortic dissections and reduce the incidence of serious complication. The severity of the underlying disease justifies high mortality rates. The learning curve is a reality.

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Advances in the diagnosis of acute aortic syndromes: Role of imaging techniques

Cited by 22 publications

References 69 publications

Intravascular ultrasound assisted sizing in thoracic endovascular aortic repair improves aortic remodeling in Type B aortic dissection

Intravascular ultrasound assisted sizing in thoracic endovascular aortic repair improves aortic remodeling in Type B aortic dissection

Computed tomography angiography-negative aortic dissection in a patient using Phencyclidine

Treatment of Acute Aortic Dissections: A Single Centre Experience

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