The Annals of Thoracic Surgery

2007

DOI: 10.1016/j.athoracsur.2006.08.031

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Results After Endovascular Stent Graft Placement in Atherosclerotic Aneurysms Involving the Descending Aorta

¹

,

²

,

³

et al.

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Discussion1

Cardiac Imaging: Focal Contrast Enhancement Of Intramural He1

Implications For Stent Grafting1

Acute Aortic Syndromes1

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Cited by 81 publications

(56 citation statements)

References 34 publications

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“…10,33 Dissection flaps that extend to or into the origin of the LSCA complicate the achievement of a seal using a simple cylindrical device. The physiology of blood flow at the origin of the LSCA can be extremely complex, with communication between aortic and LSCA true and false lumens, and directions of flow varying with different phases of the cardiac cycle.…”

Section: Discussionmentioning

confidence: 99%

“…[3][4][5][6][7][8] Continued pressurization and perfusion of the false lumen due to endoleak, however, is frequently seen after stent-graft repair of aortic dissection. 9,10 Compared with endoleaks encountered after thoracic endovascular aneurysm repair, endoleak physiology in aortic dissection is complex and incompletely understood.…”

mentioning

confidence: 99%

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Factors Portending Endoleak Formation After Thoracic Aortic Stent-Graft Repair of Complicated Aortic Dissection

¹

,

²

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³

et al. 2009

Circ: Cardiovascular Interventions

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Background-Endoleaks after stent-graft repair of aortic dissections are poorly understood but seem substantially different from those seen after aneurysm repair. We studied anatomic and clinical factors associated with endoleaks in patients who underwent stent-graft repair of complicated type B aortic dissections. Methods and Results-From 2000 to 2007, 37 patients underwent stent-graft repair of acute (Յ14 days; nϭ23), subacute (15 to 90 days; nϭ10) or chronic (Ͼ90 days; nϭ4) complicated type B aortic dissections using the Gore Thoracic Excluder (nϭ17) or TAG stent-grafts (nϭ20) under an investigator-sponsored protocol. Endoleaks were classified as imperfect proximal seal, flow through fenestrations or branches, or complex (both). Variables studied included coverage of the left subclavian artery, aortic curvature, completeness of proximal apposition, dissection chronicity, and device used. Endoleaks were found during follow-up (mean, 22 months) in 59% of patients, and they were associated with coverage of the left subclavian artery (complex, PϽ0.001), small radius of curvature (type 1 and complex, Pϭ0.05), and greatest length of unapposed proximal stent graft (complex, PϽ0.0001). During follow-up, 10 endoleaks resolved spontaneously, 6 required reintervention for false lumen dilatation, and 2 were stable without clinical consequences. Conclusions-Endoleaks are common after stent-graft repair of aortic dissection and may lead to false lumen enlargement necessitating reintervention. Anatomic complexities such as acute aortic curvature and covered side branches were associated with endoleaks, illustrating the need for dissection-specific device development.

“…10,33 Dissection flaps that extend to or into the origin of the LSCA complicate the achievement of a seal using a simple cylindrical device. The physiology of blood flow at the origin of the LSCA can be extremely complex, with communication between aortic and LSCA true and false lumens, and directions of flow varying with different phases of the cardiac cycle.…”

Section: Discussionmentioning

confidence: 99%

“…[3][4][5][6][7][8] Continued pressurization and perfusion of the false lumen due to endoleak, however, is frequently seen after stent-graft repair of aortic dissection. 9,10 Compared with endoleaks encountered after thoracic endovascular aneurysm repair, endoleak physiology in aortic dissection is complex and incompletely understood.…”

mentioning

confidence: 99%

Factors Portending Endoleak Formation After Thoracic Aortic Stent-Graft Repair of Complicated Aortic Dissection

¹

,

²

,

³

et al. 2009

Circ: Cardiovascular Interventions

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Background-Endoleaks after stent-graft repair of aortic dissections are poorly understood but seem substantially different from those seen after aneurysm repair. We studied anatomic and clinical factors associated with endoleaks in patients who underwent stent-graft repair of complicated type B aortic dissections. Methods and Results-From 2000 to 2007, 37 patients underwent stent-graft repair of acute (Յ14 days; nϭ23), subacute (15 to 90 days; nϭ10) or chronic (Ͼ90 days; nϭ4) complicated type B aortic dissections using the Gore Thoracic Excluder (nϭ17) or TAG stent-grafts (nϭ20) under an investigator-sponsored protocol. Endoleaks were classified as imperfect proximal seal, flow through fenestrations or branches, or complex (both). Variables studied included coverage of the left subclavian artery, aortic curvature, completeness of proximal apposition, dissection chronicity, and device used. Endoleaks were found during follow-up (mean, 22 months) in 59% of patients, and they were associated with coverage of the left subclavian artery (complex, PϽ0.001), small radius of curvature (type 1 and complex, Pϭ0.05), and greatest length of unapposed proximal stent graft (complex, PϽ0.0001). During follow-up, 10 endoleaks resolved spontaneously, 6 required reintervention for false lumen dilatation, and 2 were stable without clinical consequences. Conclusions-Endoleaks are common after stent-graft repair of aortic dissection and may lead to false lumen enlargement necessitating reintervention. Anatomic complexities such as acute aortic curvature and covered side branches were associated with endoleaks, illustrating the need for dissection-specific device development.

“…All axial CT of the existence of a "micro intimal tear" has been suggested ( 11-15 ), the prevalence and the natural history of focal contrast enhancement have not been investigated by using serial follow-up imaging. Along with widespread use of less invasive endovascular stent-graft placement (16)(17)(18), endovascular treatment in patients with focal contrast enhancement to prevent progression to AD is increasingly advocated; however, this is without any information on the outcomes of patients with focal contrast enhancement that may support this intervention. Endovascular treatment markedly reduced hematoma in several studies, but these studies included only a few patients ( 19,20 ), which suggests a need for in-depth analysis of observational data from a sizable number of patients to characterize this feature and to improve our knowledge of its natural history.…”

Section: Cardiac Imaging: Focal Contrast Enhancement Of Intramural Hementioning

confidence: 99%

Distal Aortic Intramural Hematoma: Clinical Importance of Focal Contrast Enhancement on CT Images

Park¹,

Ahn²,

Kim³

et al. 2011

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Purpose:To investigate the prevalence, fate, and effect of focal contrast enhancement lesion within the hematoma on contrast material-enhanced computed tomographic (CT) images in patients with distal aortic intramural hematoma (IMH). Materials and Methods:This retrospective study was approved by the institutional review board; informed consent was waived. Clinical and CT data in 107 patients with distal IMH who received medical treatment were analyzed, including remodeling processes of IMH at follow-up CT. IMH progression was defi ned as development of aortic dissection (AD) and aneurysm or hematoma increase. Results:The frequency of focal contrast enhancement was 39.3%, and hematoma was thicker in patients with focal contrast enhancement than in those without (12.3 mm 6 3.6 [standard deviation] vs 10.1 mm 6 4.1, P = .006). Although development of AD occurred more frequently in patients with focal contrast enhancement (21 % vs 3%, P = .006), hematoma resorption (57% vs 71%) was the most common pattern of remodeling in both groups without any signifi cant difference ( P = .148). The frequency of development of aortic aneurysm (17% vs 14%, P = .690) and increase of hematoma (0% vs 5%, P = .278) was not signifi cantly different between groups. The 1-, 3-, 5-, and 7-year survival rates were 96.3% 6 1.8, 95.2% 6 2.1, 87.9% 6 3.4, and 80.7% 6 4.4, respectively. Patients with IMH progression showed lower survival rates than those without ( P = .028). While no signifi cant difference in the overall survival rates could be demonstrated in patients with and those without focal contrast enhancement ( P = .442), our study had only 17% power to detect a difference of 10%. Initial maximal aortic diameter was the only factor associated with survival rates (hazard ratio = 1.129 ; 95% confi dence interval: 1.063, 1.199). The optimal cutoff for prediction of mortality within 7 years was 41 mm. Conclusion:Urgent intervention for patients with focal contrast enhancement is not necessary during the acute stage, and long-term close monitoring with imaging is a better option considering diverse remodeling processes of distal IMH.q RSNA, 20111 From the Divisions of Cardiology

“…The summarized results of endovascular repair are condensed in Table 1. 11,[35][36][37][38][39][40] Note that these studies included limited numbers of patients and relatively modest follow-up periods.…”

Section: Implications For Stent Graftingmentioning

confidence: 99%

Surgical Management of Descending Thoracic Aortic Disease: Open and Endovascular Approaches

et al. 2010

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