Surgical Treatment or Conservative Therapy for Stanford Type A Acute Aortic Dissection with a Thrombosed False Lumen

Ando, Takashi; Kobayashi, Toshiya; Endo, Hitoshi; Nagata, Tokuichiro; Ono, Hirokuni; Suzuki, Tomohiro; Murakami, Hiroshi; Chikada, Masahide; Makuuchi, Haruo

doi:10.3400/avd.oa.12.00021

Cited by 7 publications

(9 citation statements)

References 28 publications

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“…While without operation outcome is inacceptable (4,5), the use of extracorporeal circulation with hypothermic circulatory arrest is the gold-standard (6).…”

Section: Introductionmentioning

confidence: 99%

Is the outcome in acute aortic dissection type A influenced by of femoral versus central cannulation?

Klotz¹,

Bucsky²,

Richardt³

et al. 2016

Ann. Cardiothorac. Surg.

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Background: The purpose of this study was to evaluate the single-center experience in initial femoral versus central cannulation of the extracorporeal circulation for acute aortic dissection type A (AADA). Conclusions: AADA can be operated with both femoral and central cannulation with similar results. Risk for early mortality was driven by the preoperative clinical and hemodynamic status before operation rather than the cannulation technique. Methods

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“…While without operation outcome is inacceptable (4,5), the use of extracorporeal circulation with hypothermic circulatory arrest is the gold-standard (6).…”

Section: Introductionmentioning

confidence: 99%

Is the outcome in acute aortic dissection type A influenced by of femoral versus central cannulation?

Klotz¹,

Bucsky²,

Richardt³

et al. 2016

Ann. Cardiothorac. Surg.

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“…The treatment for dissection with thrombosed false lumen at the ascending aorta is still controversial. [8][9][10] Like this case, if the frequency of venous thrombosis with ADD is higher with the patient performed medical therapy than surgical, it might be one of the reasons that surgical therapy is recommended for the treatment of ADD.…”

Section: Discussionmentioning

confidence: 99%

Acute Pulmonary Thromboembolism and Deep Vein Thrombosis during the Medical Treatment of Acute Aortic Dissection was Successfully Treated by the Combination of Inferior Vena Cava Filter Installation and Anti-Coagulant Therapy: A Case Report

Kagawa

Ota²,

Hoshino

et al. 2015

Annals of Vascular Diseases

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A 71-year-old woman was admitted with Stanford type A acute aortic dissection (AAD). Computed tomography (CT) revealed thrombosis of the false lumen, and we planned to treat medically. She developed transient pleural effusion and hypoxemia, which persisted despite her pleural effusion disappeared. We performed CT and found a large thrombus in the pulmonary artery and femoral vein. We administered low doseunfractionated heparin and installed a retrievable inferior vena cava fi lter, which caused the thrombus in the pulmonary artery to disappeared without exacerbating AAD. Our strategy seems to be suitable for acute pulmonary thromboembolism that occurs during the treatment of AAD.Keywords: acute aortic dissection, acute pulmonary thromboembolism, deep vein thrombosis auscultation, respiratory sounds were clear, and no murmurs were detected. A laboratory examination demonstrated a white blood cell count of 12100/µL, a hemoglobin concentration of 13.0 mg/dL, and a platelet count of 22.9 × 10 4 /µL. Blood biochemical tests produced normal results, including an aspartate aminotransferase level of 17 IU/L, an alanine aminotransferase concentration of 15 IU/L, a creatinine kinase concentration of 71 IU/L, and a creatinine level of 0.58 mg/dL. A troponin T test produced negative results. However, a coagulation test showed that the patient's D-dimer (60.9 µg/mL) levels were markedly elevated. Electrocardiography revealed a normal sinus rhythm, and did not detect any signifi cant ST-T wave changes (Fig. 1). Chest radiography demonstrated mediastinal widening, but no pleural effusion was observed (Fig. 2). Contrast-enhanced computed tomography (CT) depicted an acute aortic dissection (AAD), which extended from the ascending aorta to the common iliac artery (Fig. 3). A transthoracic echocardiographic examination did not detect any aortic regurgitation, pericardial effusion, or dilatation of right heart. So, we diagnosed the patient with a Stanford type A AAD. As complete thrombosis of the aortic false lumen was achieved on admission, the patient was treated with antihypertensive agents.The clinical course of the patient's AAD was good, and she underwent rehabilitation according to the program recommended by the appropriate treatment guidelines. 1) However, transient pleural effusion was showed to develop on chest radiography of day 4, and we considered that this would reduce the patient's oxygen saturation level. Although the pleural effusion subsequently disappeared on chest radiography of day 12, the patient's oxygen saturation level remained low (about 85%) in room air. Rehabilitation did not progress because of hypoxemia, and sometimes she walked only in the room with oxygen Case ReportA 71-year-old woman with a history of hypertension suffered a 2-hour episode of sudden severe back pain and visited our hospital. Her height was 160 cm and her weight was 70 kg. Her blood pressure was 170/90 mmHg in both arms, her heart rate was 55 beats per minute, and her oxygen saturation level was 100% in room air. On 36

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“…Persistent patent false lumen in the aorta is common in AAAD and may be associated with poor long-term prognosis. [57][58][59][60][61][62][63][64][65][66][67][68][69][70][71][72] Analysis of the natural history of the residual aorta after AAAD repair provides insight into the outcomes for patients with persistent patent false lumen. The presence of a patent false lumen has been shown to be a significant risk factor for aortic enlargement, increasing the likelihood for reoperation.…”

Section: Fate Of the False Lumenmentioning

confidence: 99%

Repair of Acute Type-A Aortic Dissection in the Present Era: Outcomes and Controversies

Moeller

Nores

Stamou

2019

Aorta

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Acute Type-A aortic dissection (AAAD) remains a surgical emergency with a relatively high operative mortality despite advances in medical and surgical management over the past three decades. In spite of the severity of disease, there is a paucity of studies reviewing key controversies surrounding AAAD repair and management. A systematic literature search was performed using Cochrane review and PubMed bibliography review. Abstracts were first reviewed for general pertinence and then articles were reviewed in full. Literature review indicates that use of moderate hypothermia and antegrade cerebral perfusion is a safe alternative to deep hypothermia. In hemodynamically stable patients, axillary cannulation may be substituted for femoral cannulation. With regard to the technical aspects of repair, preserving the aortic root whenever possible and performing the distal anastomosis with the open distal technique rather than with the clamp on is the preferred approach. In patients with a patent false lumen, close monitoring is indicated. As demonstrated by the literature, significant improvement of early and late mortality over the past years has occurred in patients presenting with AAAD. Repair of acute Type-A aortic dissection remains a challenge with high operative mortality; however, improvement of surgical techniques and management have resulted in improvement of early and late clinical outcomes.

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Surgical Treatment or Conservative Therapy for Stanford Type A Acute Aortic Dissection with a Thrombosed False Lumen

Cited by 7 publications

References 28 publications

Is the outcome in acute aortic dissection type A influenced by of femoral versus central cannulation?

Is the outcome in acute aortic dissection type A influenced by of femoral versus central cannulation?

Acute Pulmonary Thromboembolism and Deep Vein Thrombosis during the Medical Treatment of Acute Aortic Dissection was Successfully Treated by the Combination of Inferior Vena Cava Filter Installation and Anti-Coagulant Therapy: A Case Report

Repair of Acute Type-A Aortic Dissection in the Present Era: Outcomes and Controversies

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