Aiming at One-Stage Corrective Surgery for Extended Thoracic Aortic Dilatation

Niinimaki, Eetu; Kajander, Henri; Paavonen, Timo; Sioris, Thanos; Mennander, Ari

doi:10.1055/s-0034-1370887

Cited by 2 publications

(1 citation statement)

References 25 publications

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“…The GCA aortitis is associated with an elevated risk of aneurysm and acute aortic syndrome's developing due to thoracic aortic rupture or dissection [11][12][13]. The pathogenesis of ascending aorta's dilatation is attributed to the inflammation of its wall [14] and accelerated atherosclerosis developing on the background of glucocorticoid (GC) medication [15], there is also a high probability of Chlamidia pneumonia and anaerobic involvement [16][17]. Apart from atherosclerosis and arterial hypertension (AHT), the role of non-infectious diseases in the development of aortitis and its complications is not conclusively proven.…”

Section: Introductionmentioning

confidence: 99%

Ревматическая Полимиалгия В Клинических Рекомендациях 2018–2020 Гг. Часть II: Диагностика Васкулита

Puzanova¹,

Лызиков²

2021

PJS

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The issue of improved diagnosis of both rheumatic diseases of the elderly and aortic diseases does not lose its relevance. In terms of aortic aneurysms, dissection and ruptures and their attended pathogenesis, both inflammation and structural wall damages may be detected with imaging methods whose role is vital. A number of international guidelines deal with the management of polymyalgia rheumatica, giant cell arteritis, or aortic aneurysms. Aortitis is associated with up to 40 % of polymyalgia rheumatica’s cases. The clinical suspicion of aortitis is based on the detection of blood pressure and pulse asymmetry, aortic regurgitation murmur, vascular bruits, as well as persistent polymyalgia rheumatica or inflammatory dorsalgia, pelvis or leg pain. In 2020, the positron emission tomography/computed tomography’s use is approved by the Italian Society for Rheumatology for the diagnosis of vasculitis attended by polymyalgia rheumatica at the secondary healthcare level and by the European Headache Federation for the diagnosis of large vessel giant cell arteritis in the neurological practice. A review of the guideline by the European Association of Nuclear Medicine, the Society of Nuclear Medicine and Molecular Imaging, and the American Society of Nuclear Cardiology (2018) was performed in terms of positron emission tomography with fluorodesoxyglucose combined with computed tomography (angiography) imaging in large vessel vasculitis and polymyalgia rheumatica. It is further compared with the clinical guidelines, other guidelines by the societies of nuclear medicine and new scientific data. Both procedure and patient’s preparation for examination are decribed. The criteria for assessing vasculitis proposed for either clinical practice or clinical studies are considered, as well as the factors influencing the test results and their interpretation (such as atherosclerosis, diabetes, age, body mass index, glucemia’s and acute phase markers’ levels). The guideline substantiates the benefit of both positron emission tomography’s use and its combination with computed tomography to detect extracranial vasculitis, as well as the value of performing computed tomography-angiography at different stages of the disease. There is a need to strengthen evidence on both standard time of fluorodesoxyglucose exposure and the benefit of combining positron emission tomography with computed tomography-angiography, in particular for detection of vasculitis relapses. Finding a consensus for early test’s performing is needed, as well as its score standardization, ensuring reimbursement and implementation of new imaging techniques for the cranial vessels. In the future, the evidence-based approach to managing vasculitis will be supplemented by teranostics.

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Section: Introductionmentioning

confidence: 99%

Ревматическая Полимиалгия В Клинических Рекомендациях 2018–2020 Гг. Часть II: Диагностика Васкулита

Puzanova¹,

Лызиков²

2021

PJS

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Treatment of right-sided aortic arch aneurysms with aberrant left subclavian artery with Kommerell’s diverticulum using the frozen elephant trunk technique

Juraszek,

Berger,

Kreibich

et al. 2023

Interdisciplinary CardioVascular and Thoracic Surgery

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OBJECTIVES The ideal treatment for aneuryms of aberrant left subclavian arteries with Kommerell's diverticulum arising from right aortic arches remains open. METHODS Between January 2015 and December 2020, 5 patients with aneurysms from a right-sided aortic arch with aberrant left subclavian artery and Kommerell’s diverticulum underwent repair by using the frozen elephant trunk technique in 3 aortic centres. Patients’ characteristics were retrospectively reviewed and the surgical procedure and outcomes are presented. RESULTS The median age of the 2 male and 3 female patients was 59 (range from 49 to 63) years. The median operative times were as follows: surgery 405 min (range from 335 to 534), cardiopulmonary bypass time 244 min (range from 208 to 280) and aortic clamp time 120 min (from 71 to 184). The mean core temperature was 25.94°C (from 24 to 28). The intensive care unit stay was 4 days (range from 1 to 8) and the in-hospital stay 21 days (from 16 to 34). All patients were discharged and we observed no stroke or spinal cord ischaemia postoperatively. During the median follow-up time of 1003 days (range from 450 to 2306), 3 patients required subsequent thoracic endovascular distal stent graft extension. CONCLUSIONS The frozen elephant trunk technique is a good treatment option for patients with aneuryms of an aberrant left subclavian artery with Kommerell's diverticulum arising from right aortic arches. Secondary stent graft extension is a frequently needed component of the treatment concept.

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Aiming at One-Stage Corrective Surgery for Extended Thoracic Aortic Dilatation

Cited by 2 publications

References 25 publications

Ревматическая Полимиалгия В Клинических Рекомендациях 2018–2020 Гг. Часть II: Диагностика Васкулита

Ревматическая Полимиалгия В Клинических Рекомендациях 2018–2020 Гг. Часть II: Диагностика Васкулита

Treatment of right-sided aortic arch aneurysms with aberrant left subclavian artery with Kommerell’s diverticulum using the frozen elephant trunk technique

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