Acute Type A Dissection Causing Impending Rupture of Abdominal Aortic Aneurysm Previously Treated with EVAR

Ogawa, Yoshiaki; Watkins, A. Claire; Lee, Anson; Iwakoshi, Shinichi; Dua, Anahita; Pedroza, Albert J; Dake, Michael D.; Lee, Jason T.

doi:10.1016/j.avsg.2019.11.047

Cited by 4 publications

(4 citation statements)

References 8 publications

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“…The most common treatment in these cases was thoracic EVAR (TEVAR), with which a false lumen is potentially thrombosed and its pressure is decreased. In a case similar to ours, TAAD was treated with TEVAR, but unsuccessfully, since it only prolonged the patient’s survival to open repair with endograft replacement, which is another treatment option [ 11 ]. Additionally, most data reports TAAD following TEVAR rather than abdominal EVAR, with a postprocedural TAAD incidence of about 6.8%.…”

Section: Discussionmentioning

confidence: 99%

“…TAAD following EVAR is a rare and challenging problem, which can lead to severe consequences such as expansion or rupture of the aneurysm, or endograft collapse with malperfusion due to excessive pressure in the false lumen from the lack of outflow [11]. The majority of reported aortic dissections following EVAR are Stanford type B [12][13][14].…”

Section: Discussionmentioning

confidence: 99%

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Delayed Stanford Type A Aortic Dissection After Endovascular Repair of Abdominal Aortic and Common Iliac Artery Aneurysms Resulting in Stent Graft Collapse: A Case Report

Lah,

Cvetko,

Breznik

2024

Cureus

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We discuss a rare case of Stanford type A aortic dissection (TAAD) occurring several months after endovascular aneurysm repair (EVAR) of the abdominal aortic and the common iliac artery (CIA) aneurysms. The patient underwent urgent surgery for TAAD treatment but died on the table due to intractable bleeding. We conclude that TAAD was likely unrelated to the initial EVAR procedure but rather to atherosclerosis, hypertension, and prior aortic valve replacement. Only a few cases in the literature report TAAD and total collapse of the abdominal aortic stent graft.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Delayed Stanford Type A Aortic Dissection After Endovascular Repair of Abdominal Aortic and Common Iliac Artery Aneurysms Resulting in Stent Graft Collapse: A Case Report

Lah,

Cvetko,

Breznik

2024

Cureus

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“…To our knowledge, only one TAAD after EVAR has been previously described in the literature. In that case, TAAD occurred eight years after an EVAR for an AAA and recent endovascular Type IB endoleak repair through brachial artery access [ 5 ]. CTA showed iatrogenic TAAD extending from the ascending aorta into the AAA, which continued to grow despite emergent hemiarch replacement and TEVAR.…”

Section: Discussionmentioning

confidence: 99%

“…Rarely, aortic dissections have been documented following EVAR, leading to graft collapse, impending rupture of an AAA, and distal malperfusion. The majority of these cases were Type B aortic dissections (TBAD) [ 5 ]. The present case report describes a Type A aortic dissection (TAAD) following endovascular repair of an isolated external IAA, which required open sternotomy with aortic valve replacement (AVR) and aortic graft to seal the entry tears.…”

Section: Introductionmentioning

confidence: 99%

Type A Thoracic Aortic Dissection Following Endovascular Repair of a Common Iliac Artery Aneurysm

Wolfers¹,

Qian²,

Montorfano³

et al. 2021

Cureus

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We discuss a rare case of acute Type A thoracic aortic dissection (TAAD) following endovascular aneurysm repair (EVAR) of a common iliac artery aneurysm, which likely resulted from complications due to aberrant anatomy. Valve replacement, ascending aortic arch graft, and entry tear suture repair were necessary to contain the TAAD. Postoperative computed tomography with angiography (CTA) demonstrated stable disease, and the patient remained asymptomatic. Open and endovascular repair of the descending abdominal aorta was avoided. Few cases in the literature report TAAD following EVAR. Detection and repair of the entry site was crucial for containing the TAAD.

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Time-dependent mechanical behaviour of the aortic chronic dissection flap

Panpho

Yang

Davies

et al. 2022

Interactive CardioVascular and Thoracic Surgery

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OBJECTIVES The transition of aortic dissection from acute to chronic is poorly understood. We examined time-dependent mechanical behaviour and biochemical properties of chronic dissection tissues. METHODS Aorta samples were obtained from 14 patients with mixed aetiology who were undergoing elective surgery for chronic dissected aneurysms, ranging from 3 months to 15 years post-dissection. The tissue elastic modulus and tissue deformation following application of loading for 5 h were measured for the false lumen (FL), true lumen (TL) and flap (FP) tissues with a custom-indentation technique. Collagen, elastin and glycosaminoglycan levels were determined with established biochemical assays. Elastin fragmentation was graded from histological sections. The number of tissues characterized was as follows: FP (n = 10), TL (n = 5 for biomechanical testing, n = 8 for biochemical analysis, n = 8 for histological assessment) and FL (n = 4). RESULTS Tissues stiffness was highest in FP [59.8 (14.8) kPa] as compared with TL [50.7 (6.2) kPa] and FL [40.5 (4.7) kPa] (P = 0.023 and P = 0.006, respectively). FP [0.5 (0.08) mm] also exhibited reduced deformation relative to TL [0.7 (0.02) mm] and FL [0.9 (0.08) mm] (P = 0.003 and P = 0.006, respectively), lowest collagen concentration [FP: 40.1 (19.6) µg/mg, TL: 59.9 (19.5) µg/mg, P = 0.008; FL: 79.1 (32.0) µg/mg, P = 0.006] and the lowest collagen: elastin ratio [0.4 (0.1)] relative to the other tissues [TL; 0.6 (0.3), P = 0.006, FL; 1.5 (0.4); P = 0.003]. Significant elastin loss was evident in the FL-stained tissue sections whereas highly aligned, long fibres were visible in the FP and TL. A linear relationship was found between the stiffness, deformation and the time from the dissection event to surgical intervention for the FP. All data are presented as median (interquartile range). CONCLUSIONS FP exhibited reduced time-dependent deformation and distinct biochemical properties relative to TL and FL irrespective of connective tissue disorder or the anatomical region of the dissection.

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Acute Type A Dissection Causing Impending Rupture of Abdominal Aortic Aneurysm Previously Treated with EVAR

Cited by 4 publications

References 8 publications

Delayed Stanford Type A Aortic Dissection After Endovascular Repair of Abdominal Aortic and Common Iliac Artery Aneurysms Resulting in Stent Graft Collapse: A Case Report

Delayed Stanford Type A Aortic Dissection After Endovascular Repair of Abdominal Aortic and Common Iliac Artery Aneurysms Resulting in Stent Graft Collapse: A Case Report

Type A Thoracic Aortic Dissection Following Endovascular Repair of a Common Iliac Artery Aneurysm

Time-dependent mechanical behaviour of the aortic chronic dissection flap

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