Decreased Abdominal Aortic Aneurysm Size Following EVAR in Patients With CT Evidence of Subclinical Thoracic Aortic Dissection

Miner, Grace H.; Taubenfeld, Ella; Tadros, Rami O.; Han, Daniel; Marin, Michael L.

doi:10.1016/j.avsg.2019.10.091

Cited by 4 publications

(4 citation statements)

References 36 publications

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“… 4 , 8 Furthermore, the remodeling of an undetected aortic dissection may be a precursor for infrarenal AAA and the two events may not always be mutually exclusive. 16 Although the stent graft material might play a role in susceptibility of collapse, the number of reported cases is too small to draw definitive conclusions. Both nitinol, as in the current case, and stainless steel 6 devices have been reported to collapse.…”

Section: Discussionmentioning

confidence: 99%

Collapsed endograft and lower limb ischemia from type B dissection repaired with thoracic endovascular aortic graft and iliac stenting: A case report and review of the literature

Cooke

Bai

George

et al. 2022

Journal of Vascular Surgery Cases, Innovations and Techniques

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Section: Discussionmentioning

confidence: 99%

Collapsed endograft and lower limb ischemia from type B dissection repaired with thoracic endovascular aortic graft and iliac stenting: A case report and review of the literature

Cooke

Bai

George

et al. 2022

Journal of Vascular Surgery Cases, Innovations and Techniques

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“…There is increasing evidence that AD and AAA are likely not truly distinct clinical entities and the presence of one may have an effect on treatment outcomes of the other. 11 Furthermore, the pre-existing diagnosis of MFS added a unique challenge. The aortic tissue in MFS degenerates over time and ultimately requires multiple operative interventions to replace the entire aorta.…”

Section: Discussionmentioning

confidence: 99%

Acute dissection into a large abdominal aortic aneurysm in a patient with Marfan syndrome

2022

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Objectives Synchronous aortic dissection (AD) with involvement of pre-existing infrarenal abdominal aortic aneurysms (AAAs) are fortunately rare. Extension of the dissection flap to involve the aneurysm is particularly dangerous with pressurization of the false lumen within a diseased aortic wall. The aim of this article is to present a unique case of an acute AD with extension to involve a large AAA in a patient with an underlying connective tissue disorder Methods A 24-year-old male Marfan syndrome patient with prior type A dissection repair presented with a descending thoracic AD and a separate 7.0-cm infrarenal AAA. He was initially medically managed but developed acute extension of the dissection flap to involve the large aneurysm. Results The patient was initially treated with open infrarenal aortic replacement under left atrialfemoral artery bypass. Three years later, he developed degeneration of the residual aorta and underwent a two-stage hybrid repair. He underwent an additional stent graft for a distal anastomotic leak. At 5 years of follow-up, there was positive aneurysm remodeling and sac regression. Conclusion This case illustrates the challenges in treating a patient with synchronous aortic processes. False lumen pressurization of a large aneurysm wall is fortunately rare but can be lethal. Prompt intervention is required but the presence of an underlying connective tissue disorder may limit endovascular treatment options. Careful case planning is mandatory and multiple interventions should be anticipated.

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“…14 It is understood that pathologies and morphologies of the aorta can influence AAA sac behavior and outcomes following EVAR. [15][16][17] Various indices of Iliac tortuosity have been shown to be associated with complexity of EVAR and postoperative limb occlusion. 18 It has also been suggested that a quantitative tortuosity index may provide a more specific shape classification and be predictive of aneurysm rupture.…”

Section: Introductionmentioning

confidence: 99%

High Thoracic Tortuosity Is Associated With CT-Markers of Degeneration of the Descending Thoracic Aortic Wall

Gross

Cho

Taubenfeld

et al. 2022

Vasc Endovascular Surg

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Objective/Introduction Increased vascular tortuosity may be an independent marker of generalized aortic pathology. This study investigates the association between descending thoracic aortic tortuosity, aneurysm pathophysiology, and outcomes following EVAR in AAA patients. Methods Patients who underwent elective EVAR between 2004 and 2018 were reviewed. Thoracic tortuosity index (TTI) was measured using 3D reconstruction software. Patients were dichotomized across the median TTI into high tortuosity [HT] (TTI >1.27, Figure1(a) ) and low tortuosity [LT] (TTI ≤1.27, Figure 1(b) ) groups. Perioperative complications, postoperative outcomes, and CT-based features of thoracic aortic wall degeneration ( Figure 1(c)-(e) ) were collected and analyzed. Results 136 patients underwent treatment: 70 HT patients, including 54 males and 16 females (mean age: 77 years), and 66 LT patients, including 62 males and 4 females (mean age: 70 years) (age; P < .001). LT patients exhibited greater prevalence of hypercholesterolemia and diabetes (P = .045, P = .01). Presence of degenerative aortic wall markers was greater in HT patients (P = .045). HT patients had higher incidence of multiple aneurysms concurrently present in their aorta compared to LT (32.8% vs 11.3%; P = .002). Frequency of AAA rupture/dissection was 4.3% for HT and 1.5% for LT (P = .339). A trend was observed in all cause 30-day mortality in the HT group (P = .061). Other perioperative complications and postoperative outcomes were similar between groups. Conclusion High TTI was associated with older age at time of EVAR, greater prevalence of degenerative markers in the descending thoracic aortic wall, and widespread aorto-iliac dilation. While not predictive of EVAR outcomes, TTI can provide valuable information regarding aneurysm pathophysiology.

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Decreased Abdominal Aortic Aneurysm Size Following EVAR in Patients With CT Evidence of Subclinical Thoracic Aortic Dissection

Cited by 4 publications

References 36 publications

Collapsed endograft and lower limb ischemia from type B dissection repaired with thoracic endovascular aortic graft and iliac stenting: A case report and review of the literature

Collapsed endograft and lower limb ischemia from type B dissection repaired with thoracic endovascular aortic graft and iliac stenting: A case report and review of the literature

Acute dissection into a large abdominal aortic aneurysm in a patient with Marfan syndrome

High Thoracic Tortuosity Is Associated With CT-Markers of Degeneration of the Descending Thoracic Aortic Wall

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