Pseudoaneurysm of the aortic arch

Lu, Yuan-Qiang; Yao, Feng; Shang, An-Dong; Pan, Jiadong

doi:10.1097/md.0000000000004457

Cited by 8 publications

(3 citation statements)

References 18 publications

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“…In our series, TAP with massive hemoptysis, haematemesis or hematochezia was indications for emergent TEVAR, besides ruptured descending thoracic aortic aneurysms, acute BTAI and complicated acute type B aortic dissections [ 42 ]. Massive hemoptysis, haematemesis or hematochezia occurred due to aortopulmonary fistula (APF) or AEF even with a visible intrabronchial or intraesophageal mass [ 26 , 43 – 48 ]. There was no detectable APF in our patients manifested as hemoptysis, albeit in one patient who complained of persistent hemoptysis for even seven years after TEVAR.…”

Section: Discussionmentioning

confidence: 99%

Zone 2/3 lesion and emergency repair as potential mortality predictors of TEVAR for thoracic aortic pseudoaneurysm

Wang,

Shu,

Wang

et al. 2023

J Cardiothorac Surg

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Objective Thoracic aortic pseudoaneurysm (TAP) is an uncommon but life-threatening condition. The present study aimed to investigate the early and midterm clinical outcome of TAP patients following TEVAR and identify potential mortality predictors. Methods We retrospectively reviewed a series of 37 eligible patients with TAP admitted to our hospital from July 2010 to July 2020. We explored their baseline, perioperative and follow-up data. Fisher exact test and Kaplan–Meier method were applied for comparing difference between groups. Results There were 29 men and 12 women, with the mean age as 59.5 ± 13.0 years (range 30–82). The mean follow-up period was 30.7 ± 28.3 months (range 1–89). For early outcome (≤ 30 days), mortality happened in 3 (8.1%) zone 3 TAP patients versus 0 in zone 4 (p = 0.028); postoperative acute arterial embolism of lower extremity and type II endoleak respectively occurred in 1(2.7%) case. For midterm outcome, survival at 3 months, 1 year and 5 years was 88.8%, 75.9% and 68.3%, which showed significant difference between zone 2/3 versus zone 4 group (56.3% vs. 72.9%, p = 0.013) and emergent versus elective TEVAR group (0.0% versus 80.1%, p = 0.049). Previous stent grafting or esophageal foreign body with Aortoesophageal fistula (AEF), and systemic vasculitis, as etiologies, resulted in encouraging immediate outcome but worse midterm prognosis. Conclusion TAP lesions at zone 2/3 and emergent TEVAR predict worse midterm outcomes compared to zone 4 lesions and elective TEVAR. The outcomes are also mainly restricted by the etiology of the TAP.

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Section: Discussionmentioning

confidence: 99%

Zone 2/3 lesion and emergency repair as potential mortality predictors of TEVAR for thoracic aortic pseudoaneurysm

Wang,

Shu,

Wang

et al. 2023

J Cardiothorac Surg

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“…Aortic pseudoaneurysms are often the result of a disruption of at least one layer of the aortic wall, which is contained within the remaining vascular layers and surrounding structures 103 . Disturbed flow conditions, including elevated velocity flow, high wall shear stresses and vortical flow 105 , may lead to wall complications and pseudoaneurysm 103 , 106 . If left untreated, pseudoaneurysms are likely to result in mortality or loss of a limb 24 , 107 .…”

Section: Discussionmentioning

confidence: 99%

Impact of extra-anatomical bypass on coarctation fluid dynamics using patient-specific lumped parameter and Lattice Boltzmann modeling

Sadeghi

Tomka

Khodaei

et al. 2022

Sci Rep

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Accurate hemodynamic analysis is not only crucial for successful diagnosis of coarctation of the aorta (COA), but intervention decisions also rely on the hemodynamics assessment in both pre and post intervention states to minimize patient risks. Despite ongoing advances in surgical techniques for COA treatments, the impacts of extra-anatomic bypass grafting, a surgical technique to treat COA, on the aorta are not always benign. Our objective was to investigate the impact of bypass grafting on aortic hemodynamics. We investigated the impact of bypass grafting on aortic hemodynamics using a patient-specific computational-mechanics framework in three patients with COA who underwent bypass grafting. Our results describe that bypass grafting improved some hemodynamic metrics while worsened the others: (1) Doppler pressure gradient improved (decreased) in all patients; (2) Bypass graft did not reduce the flow rate substantially through the COA; (3) Systemic arterial compliance increased in patients #1 and 3 and didn’t change (improve) in patient 3; (4) Hypertension got worse in all patients; (5) The flow velocity magnitude improved (reduced) in patient 2 and 3 but did not improve significantly in patient 1; (6) There were elevated velocity magnitude, persistence of vortical flow structure, elevated turbulence characteristics, and elevated wall shear stress at the bypass graft junctions in all patients. We concluded that bypass graft may lead to pseudoaneurysm formation and potential aortic rupture as well as intimal hyperplasia due to the persistent abnormal and irregular aortic hemodynamics in some patients. Moreover, post-intervention, exposures of endothelial cells to high shear stress may lead to arterial remodeling, aneurysm, and rupture.

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“…In the vast majority of cases, it is caused by motor vehicle accidents or falls from heights (Bège et al, 2015). Moreover, the presence of aneurysms increases the likelihood of a vascular rupture event (Lu et al, 2016). A mesenteric artery is rarely an isolated injury.…”

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confidence: 99%