Thoracic Involvement of Type A Aortic Dissection and Intramural Hematoma: Diagnostic Accuracy—Comparison of Emergency Helical CT and Surgical Findings

Yoshida, Shigeo; Akiba, Hidenari; Tamakawa, Mitsuharu; Yama, Naoya; Hareyama, Masato; Morishita, Kiyofumi; Abe, Tomio

doi:10.1148/radiol.2282012162

Cited by 153 publications

(55 citation statements)

References 33 publications

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“…Recent advances in both image processing and acquiring technology, such as multidetector CT scans and high-resolution ECG-gated CT scans, have location of the dissection plane in almost all patients; however, when identifying the exact location of the ET, the reported incidence varies from 38% to 84%. 18-20, 37 With additional information from the patients' operative records, we were able to identify the ET in 131 patients (76.2%). However, when we re-reviewed the CT scans without the help of these records, we could only locate the ET in 111 patients (64.5%).…”

Section: Fundingmentioning

confidence: 99%

Anatomic Feasibility of Next-Generation Stent Grafts for the Management of Type A Aortic Dissection in Japanese Patients

Fujimura

Kawaguchi

Obara

et al. 2017

Circ J

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even in cases of uncomplicated TBAD, 12 and the application of this surgical technique to manage aortic dissection seems to be expanding.On the other hand, there have been only a few case series reported in the literature on the use of TEVAR for TAAD. 13-15 The use of this surgical technique for managing TAAD is complicated by multiple factors including the location of the coronary artery, involvement of arch vessels, and proximity of the aortic valve, among others, as all factors could, in theory, contribute to a potentially fatal outcome should operative complications arise. 16 The largest series reported is by Ye et al, 17 who reported the results of 45 TEVARs for Chinese patients with TAAD with excellent results. However, no large case series have been reported since, and it appears that TEVAR for TAAD is still not applicable using current devices.As a means of teasing out the anatomical problems of TAAD, a few feasibility studies have evaluated TEVAR for TAAD using the manufacturers' instructions for use S tanford type A aortic dissection (TAAD) remains the most lethal aortic emergency, with a 50% mortality rate within 48 h of onset. 1,2 The only available standard treatment is open surgical repair, 3,4 and although recent advances in perioperative management have led to improved outcomes, 5,6 TAAD is still associated with high rates of morbidity and mortality. 7-9 Moreover, because of high levels of surgical stress, approximately 20% of patients are still denied treatment. 1 Thoracic endovascular aneurysm repair (TEVAR) was originally developed as a treatment for aneurysms, but when used to close the primary entry tear (ET) of acute complicated type B aortic dissections (TBAD), it had favorable outcomes, including enlargement of the collapsed true lumen, increased flow through the true lumen, thrombus formation leading to occlusion in the false lumen, and ultimately, aortic remodeling to cure the dissection. It has already become the treatment of choice for complicated TBAD.

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Section: Fundingmentioning

confidence: 99%

Anatomic Feasibility of Next-Generation Stent Grafts for the Management of Type A Aortic Dissection in Japanese Patients

Fujimura

Kawaguchi

Obara

et al. 2017

Circ J

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“…9,14,18 IMAGING PROTOCOL MDCT is the current imaging modality of choice for AAS with a reported sensitivity of 100% and specificity of 98-99%. 3,[19][20][21][22][23] Advantages of MDCT over other imaging modalities in the diagnosis of AAS include rapid image acquisition, near universal emergency access and the ability to image and reconstruct the entire aorta in three-dimensional planes. [23][24][25] Furthermore, the ability of MDCT to accurately assess branch vessel involvement and identify aberrant vascular anatomy is vital in determining the surgical and endovascular management 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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“…5,11 Although prominent geographic or racial differences in the relative prevalence of IMH may exist between Eastern and Western countries, 12 it is interesting to observe the universal finding that the relative incidence of IMH affecting the distal aorta is much higher than that affecting the proximal aorta. The prevalence values of type A and B IMH in IRAD are 3.6% and 9.4% (35/371), respectively.…”

Section: Type a Imh: Clinical Features And Natural History With Medicmentioning

confidence: 99%

Outcomes of Patients With Acute Type A Aortic Intramural Hematoma

et al. 2009

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Background-The proper treatment option for patients with type A intramural hematoma (IMH), a variant form of classic aortic dissection (AD), remains controversial. We assessed the outcome of our institutional policy of urgent surgery for unstable patients and initial medical treatment for stable patients with surgery in cases with complications. .56). The 1-, 2-, and 3-year survival rates of IMH patients were 87.6Ϯ3.6%, 84.9Ϯ3.7%, and 83.1Ϯ4.1%, respectively. There was no statistical difference of overall survival rates between patients with IMH and surgically treated AD patients (Pϭ0.787). Conclusions-The clinical outcome of IMH patients receiving treatment by our policy was comparable to that of surgically treated AD patients. However, adverse clinical events were not uncommon with medical treatment alone, and initial aorta diameter and hematoma thickness may identify patients who might benefit from urgent surgery.

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Thoracic Involvement of Type A Aortic Dissection and Intramural Hematoma: Diagnostic Accuracy—Comparison of Emergency Helical CT and Surgical Findings

Abstract: Emergency helical CT of the thorax depicts findings that are highly accurate in the evaluation of acute type A AD and IMH.

Cited by 153 publications

References 33 publications

Anatomic Feasibility of Next-Generation Stent Grafts for the Management of Type A Aortic Dissection in Japanese Patients

Anatomic Feasibility of Next-Generation Stent Grafts for the Management of Type A Aortic Dissection in Japanese Patients

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

Outcomes of Patients With Acute Type A Aortic Intramural Hematoma

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