Endovascular Management of Thoracic Dissections

Swee, W.; Dake, Michael D.

doi:10.1161/circulationaha.107.690966

Cited by 84 publications

(63 citation statements)

References 89 publications

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“…Although the closure of a distal reentry tear is also desirable, this is not particularly necessary to achieve optimal results [12,13,17]. A favorable postinterventional outcome would constitute adequate depressurization and shrinkage of the false lumen, supplemented in an ideal scenario by a complete thrombosis of this lumen with consequent remodeling of the entire dissected aorta [18] (Figure 3).…”

Section: Indications For Endovascular Stent-graft Therapymentioning

confidence: 99%

Role of Interventional Treatment of Thoracic Aorta

Akın¹,

Ansari²,

Nienaber³

2017

Aortic Aneurysm

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An aging western and oriental population coupled with breakthrough advances in modern diagnostic imaging modalities has evoked renewed interest in the hitherto underdiagnosed acute and chronic diseases of the aorta, which also include aortic aneurysm and aortic dissection. Although classical surgical strategies still dominate the clinical management of acute and chronic pathologies of the ascending aorta and the proximal arch region, the emergence of novel endovascular concepts has ofered an interesting therapy alternative for the treatment of descending aortic pathology in suitable patients and is highly likely to evolve as the primary treatment strategy in majority of the cases. Moreover, the use of hybrid approaches combining surgical head-vessel debranching and interventional stent-graft implantation in an atempt to improve clinical outcome in aortic arch pathologies has helped avoid the high risk of open arch repair or complete replacement. Notwithstanding these recent advancements, the complex nature of the underlying vascular disease still dictates that the proposed management of every diagnosed patient is discussed in a team constituting cardiologists, cardiac surgeons, anesthesiologists, and radiologists, with the conceptualization of individualized therapeutic strategies and conducted in a center with signiicant surgical and endovascular experience.

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Section: Indications For Endovascular Stent-graft Therapymentioning

confidence: 99%

Role of Interventional Treatment of Thoracic Aorta

Akın¹,

Ansari²,

Nienaber³

2017

Aortic Aneurysm

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“…3,27 This range of coverage is important to diagnose major branch vessel involvement and to characterize the presence and severity of the resultant organ malperfusion. 27,35 Extending the image coverage to include the common femoral arteries may be of use in certain cases, to help decide the site of peripheral vascular access for endovascular management or cannulation for extracorporeal circulation during surgery. 27,35,36 While evaluation of the source data provides the foundation of MDCT image interpretation in cases of suspected AAS, multiplanar reformat assessment of the aorta is of particularly importance in evaluating the aortic root and arch for disease involvement.…”

Section: Acute Aortic Syndrome Risk Factors and Clinical Presentationmentioning

confidence: 99%

“…27,35 Extending the image coverage to include the common femoral arteries may be of use in certain cases, to help decide the site of peripheral vascular access for endovascular management or cannulation for extracorporeal circulation during surgery. 27,35,36 While evaluation of the source data provides the foundation of MDCT image interpretation in cases of suspected AAS, multiplanar reformat assessment of the aorta is of particularly importance in evaluating the aortic root and arch for disease involvement. 4,9,11 Two-and three-dimensional reconstruction techniques are also extremely useful in the communication of results to referring clinicians and in the planning of surgical and endovascular procedures in confirmed cases of AAS.…”

Section: Acute Aortic Syndrome Risk Factors and Clinical Presentationmentioning

confidence: 99%

The role of multidetector-row CT in the diagnosis, classification and management of acute aortic syndrome

Abbas¹,

Brown²,

Peebles³

et al. 2014

BJR

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The term "acute aortic syndrome" (AAS) encompasses several non-traumatic life-threatening pathologies of the thoracic aorta presenting in patients with a similar clinical profile. These include aortic dissection, intramural haematoma and penetrating atherosclerotic ulcers. These different pathological entities can be indistinguishable on clinical grounds alone and may be confused with other causes of chest pain, including myocardial infarction. Multidetector-row CT (MDCT) is the current modality of choice for imaging AAS with a sensitivity and specificity approaching 100%. Early diagnosis and accurate radiological classification is associated with improved clinical outcomes in AAS. We review the characteristic radiological features of the different pathologies that encompass AAS and highlight the vital role of MDCT in determining the management of these life-threatening conditions.

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“…It is preferable to delay surgery until the patient has been stabilized, since mortality is as high as 34% when surgical treatment is initiated during the acute phase. 15,18 Endovascular techniques are preferred to open methods because morbidity is lower 19 , and endovascular fenestrations can be used to provide communication between the false and true lumens, to depressurize the false lumen. Placement of a stent increases stability of the artery and facilitates blood flow through the true lumen, considerably reducing the complications caused by dissection.…”

Section: Discussionmentioning

confidence: 99%

Dissecção aórtica de tipo B de Stanford: relato de caso e revisão de literatura

et al. 2017

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Complex treatment of aortic dissection is still a controversial subject because of the severity of these cases and the need to treat on a case-by-case basis. Severity is related to the difficulty of diagnosis caused by nonspecific complaints and by the serious complications inherent to disease progression (aortic rupture, hypoperfusion syndrome, retrograde dissection, refractory hypertension or pain). This article reports the case of a 61-year-old male smoker with poorly controlled hypertension who suffered a Stanford type B aortic dissection. After drug-based treatment failed, the patient was treated using endovascular techniques to place an endoprosthesis with stenting. Endovascular treatment is proving to be an effective tool for definitive treatment, with a good survival rate at the end of the first year after the procedure.Keywords: aortic dissection; endovascular; Stanford type B aortic dissection. ResumoO complexo tratamento de dissecção da aorta ainda apresenta controvérsias devido à gravidade do caso e à necessidade de individualização da terapêutica. A gravidade relaciona-se ao difícil diagnóstico pelas queixas inespecíficas e pelas graves complicações inerentes à evolução da doença (ruptura aórtica, síndrome de má perfusão, dissecção retrógrada, dor ou hipertensão refratária). Este relato apresenta um homem de 61 anos, tabagista e hipertenso mal controlado, que evoluiu para dissecção aórtica de tipo B de Stanford. Foi abordado através de técnica endovascular com uso de endoprótese com stent para tratamento do caso após falha do tratamento medicamentoso. O tratamento endovascular mostrou-se uma ferramenta eficaz para o tratamento definitivo, com boa taxa de sobrevida ao final do primeiro ano após o procedimento.Palavras-chave: dissecção aórtica; endovascular; dissecção aórtica de tipo B de Stanford.

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Endovascular Management of Thoracic Dissections

Cited by 84 publications

References 89 publications

Role of Interventional Treatment of Thoracic Aorta

Role of Interventional Treatment of Thoracic Aorta

The role of multidetector-row CT in the diagnosis, classification and management of acute aortic syndrome

Dissecção aórtica de tipo B de Stanford: relato de caso e revisão de literatura

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