Management of common carotid artery dissection due to extension from acute type A (DeBakey I) aortic dissection

Charlton-Ouw, Kristofer M.; Azizzadeh, Ali; Sandhu, Harleen K.; Sawal, Ali; Leake, Samuel S.; Miller, Charles C.; Estrera, Anthony L.; Safi, Hazim J.

doi:10.1016/j.jvs.2013.03.042

Cited by 40 publications

(39 citation statements)

References 25 publications

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“…An aortic root operation was necessary in three additional patients (12%) and three others required a complete arch replacement (12%). The median durations of circulatory arrest, cross clamp, and cardiopulmonary bypass were 23 [14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33], 93 [67. , and 182 [164-208] minutes, respectively ( Table 2).…”

Section: Resultsmentioning

confidence: 99%

“…Patients with malperfusion had longer hospital lengths of stay {20 vs. 12 [8][9][10][11][12][13][14][15][16][17][18] days, P=0.006}, as well as more reoperations for postoperative hemorrhage (24.0% vs. 5.6%, P=0.01) and a greater number of postoperative CNS events (44.0% vs. 18.3%, P=0.01).…”

Section: Resultsmentioning

confidence: 99%

“…Charlton-Ouw et al reported on 43 patients with common carotid artery involvement from propagation of a proximal aortic dissection and demonstrated that 5-year stroke-free survival was similar when compared to a cohort of patients with no appreciable dissection on carotid imaging (69.7% and 73.6%, P=0.82) (15 (17). While we did not obtain routine radiographic imaging in all patients to determine the incidence of occult CNS injury, only one patient presenting with cerebral malperfusion experienced ongoing clinical manifestations postoperatively.…”

Section: Discussionmentioning

confidence: 98%

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Differential outcomes of type A dissection with malperfusion according to affected organ system

Grimm¹,

Magruder²,

Crawford³

et al. 2016

Ann. Cardiothorac. Surg.

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Background: The management of malperfusion in patients with acute Stanford type A aortic dissection is controversial. We sought to determine the rate of resolution of malperfusion following primary repair of the dissection and to identify anatomic sites of malperfusion that may require additional management. Methods:We reviewed the hospital records of patients who presented to our institution with acute type A aortic dissection. Patient demographics, operative details and post-operative course were retrospectively extracted from our institutional electronic database. Depending upon the anatomic site, malperfusion was identified by a combination of radiographic and clinical definitions. Data were analyzed using standard univariable and multivariable methods. Conclusions: Malperfusion complicating acute type A dissection can be managed in many patients by aortic replacement alone with low overall mortality. Most cases of renal and cerebral malperfusion resolved following aortic surgery. Revascularization was frequently necessary in patients with extremity malperfusion.Patients presenting with intestinal ischemia had very poor outcomes. A patient-specific approach is recommended in such complex patients.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 98%

See 1 more Smart Citation

Differential outcomes of type A dissection with malperfusion according to affected organ system

Grimm¹,

Magruder²,

Crawford³

et al. 2016

Ann. Cardiothorac. Surg.

View full text Add to dashboard Cite

show abstract

“…Although the acceptable results of immediate central aortic repair have been reported with routine central aortic repair without any special methods [58–60], a significant number of patients remain disabled, and some have shown an exacerbation and eventual death [59, 61]. Some institutions are attempting carotid artery cannulation either by direct cannulation or by end-to-side graft anastomosis to the carotid artery to quickly and safely restore the blood flow [62–65].…”

Section: Special Considerations In Cannulation Strategiesmentioning

confidence: 99%

The cannulation strategy in surgery for acute type A dissection

Abe

Usui

2016

Gen Thorac Cardiovasc Surg

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The rates of mortality and morbidity remain high in surgery for acute type A dissection. There is controversy regarding the best cannulation strategy for achieving good clinical results. Each cannulation technique has different anatomical characteristics and a different flow pattern inside the aorta during cardiopulmonary bypass. Some adverse, clinically important outcomes may be related to events at this time. Femoral artery cannulation, axillary artery cannulation, and central aortic cannulation are the three major cannulation strategies that are adopted in many centers in the world. Accumulating results from comparative studies between right axillary artery cannulation and femoral artery cannulation show that right axillary artery cannulation is associated with better clinical outcomes. However, all of the studies have been retrospective, and few studies have compared the results of other combinations of cannulation strategies. Observational studies using newer monitoring techniques clearly show that no perfusion strategy is perfect or free from complications. In summary, the evidence is insufficient to make a strong recommendation regarding cannulation strategies. Based on the fairly consistent results of retrospective studies, more surgeons are tending to switch from a retrograde perfusion strategy to adopt an antegrade perfusion strategy. Regardless of the routine cannulation strategy that is adopted, careful monitoring and a swift response to adverse events are necessary. The further accumulation of evidence is warranted.

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“…Based on our experience in management of CCAD of aortic origin and from the traumatic or spontaneous carotid dissections literature, 1,5 we recommend medical therapy with aspirin alone (81-325 mg daily), clopidogrel alone (75 mg daily), or full anticoagulation for 6 months after proximal aortic repair. Carotid revascularization should be reserved for patients with refractory ischemic symptoms referable to CCAD following adequate medical therapy.…”

Section: Oy-stersmentioning

confidence: 99%

Pearls & Oy-sters: Ophthalmic artery malperfusion in aortic dissection with common carotid artery involvement

et al. 2015

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Management of common carotid artery dissection due to extension from acute type A (DeBakey I) aortic dissection

Cited by 40 publications

References 25 publications

Differential outcomes of type A dissection with malperfusion according to affected organ system

Differential outcomes of type A dissection with malperfusion according to affected organ system

The cannulation strategy in surgery for acute type A dissection

Pearls & Oy-sters: Ophthalmic artery malperfusion in aortic dissection with common carotid artery involvement

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