Clinical significance of a false lumen pathway through the arch in acute type A aortic dissection and its influence on cervical branch compromise

Nagamine, Hiroshi; Miyazaki, Mutsuko; Wakabayashi, Naohiro; Shiba, Hiroaki; Hara, Hiroiku; Kawase, Yushi

doi:10.1093/ejcts/ezu474

Cited by 3 publications

(4 citation statements)

References 24 publications

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“…In our patient, CT demonstrated, at his first admission, the extension of the dissection into both CCA. Aortic dissection extending to extracranial right ICA with a tortuous “S” shape as in our patient was not mentioned in IRAD, Sino‐RAD, or other published studies …”

Section: Discussionmentioning

confidence: 60%

“…Aortic dissection extending to extracranial right ICA with a tortuous "S" shape as in our patient was not mentioned in IRAD, Sino-RAD, or other published studies. 8,[13][14][15] Noninvasive vascular imaging methods, such as ultrasound (US), magnetic resonance angiography (MRA), and computed tomographic angiography (CTA) are increasingly replacing conventional angiography for defining the extent of the dissection and perfusion of the arterial branches. 16,17 Recent studies suggest that all three imaging techniques have equal diagnostic value but different clinical indications.…”

Section: Mortality Of Patients With Ta-aad Has Been Reported As 26%mentioning

confidence: 99%

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Ultrasonographic detection of chronic type A aortic dissection extending to the right extracranial internal carotid artery: A case report

Sun

Dong

et al. 2019

J of Clinical Ultrasound

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We report the case of a patient with chronic type A aortic dissection (AD), who had been admitted, 18 months ago, to another hospital with acute chest‐tearing pain accompanied with transient loss of consciousness. His symptoms resolved but he reported after discharge a toothache and fluctuating right mandibular pain. He presented to our outpatient clinic because his facial pain aggravated. Physical examination demonstrated a bruit over the right carotid artery. Transthoracic echocardiography and carotid sonography demonstrated aortic dissection extending into the extracranial right internal carotid artery (ICA), which was tortuous. The patient refused surgery. This case reminds us that AD can involve the extracranial ICA, and that long‐term survival is possible with type A acute AD without treatment. Carotid ultrasonography is noninvasive, inexpensive, easily performed, and can lead to the detection of chronic type A AD extending to the extracranial ICA.

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Section: Discussionmentioning

confidence: 60%

Section: Mortality Of Patients With Ta-aad Has Been Reported As 26%mentioning

confidence: 99%

Ultrasonographic detection of chronic type A aortic dissection extending to the right extracranial internal carotid artery: A case report

Sun

Dong

et al. 2019

J of Clinical Ultrasound

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“…Distribution of the types of false lumens according to the number of junction points of the intimal flap with the aortic wall, and proportion of the aortic surface area occupied by the false lumen at the level of reference points delineating several false lumens, probably represent local segmentation of the one and same false lumen, since the true lumen generally becomes fixed near the supra-aortic trunks in the greater curvature. 22 Nagamine et al 23 described a similar cross-sectional CT aspect of "bilateral" false lumen at BCT and LSCA in about 40% type A aortic dissection, associated in 72% of the cases with an extension of the dissection to the supraaortic trunks.…”

Section: False Lumen Morphologymentioning

confidence: 87%

CT patterns of acute type A aortic arch dissection: longer, higher, more anterior

Ardellier

D’Ostrevy

Cassagnes

et al. 2017

The British Journal of Radiology

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The morphology of the dissected aortic arch differs from that of the normal arch. Thus, our compilation of aortic arch measurements may help improve existing endovascular devices and/or design of new endoprostheses. Advances in knowledge: In this article, we provide a comprehensive set of measurements of the dissected aortic arch, and show that dissected aortic arches are longer, higher, and with a more anterior apex than normal arches.

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“…However, lesions in the anterior aspect of the aortic arch were more likely to extend into the cervical branches. A false lumen pathway through the arch was strongly associated with cervical branch compromise in acute TAADs ( 22 ). Patients with primary intimal tears located in the convexity of the distal arch may be more likely to develop retrograde TAAD than patients with tears in the distal concavity ( 23 ).…”

Section: Discussionmentioning

confidence: 99%

Surgical Repair of Two Kinds of Type A Aortic Dissection After Thoracic Endovascular Aortic Repair

Fang

Warburton

et al. 2022

Front. Cardiovasc. Med.

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BackgroundRetrograde dissection is now recognized as an important complication following thoracic endovascular aortic repair (TEVAR). The purpose of this study is to describe two different situations of TAAD after TEVAR. We will introduce the surgical methods used to repair TAAD following TEVAR at our center, and evaluate its long-term prognosis.MethodsBetween January 2010 and October 2019, 50 patients who had previously received TEVAR treatment for TBAD were admitted to our center for repair of a type A aortic dissection. According to the patients’ CT angiographies and intra-operative findings, we identified two distinct groups: a retrograde group (stent-induced new aortic injury, with retrograde extension involving the ascending aorta) and an antegrade group (entry tear located in the aortic root, ascending aorta or the aortic arch, away from the edges of the stent grafts). The options for treatment of the proximal aorta were Bentall procedure (12/50, 24.0%) and ascending aorta replacement (38/50, 76.0%). All patients underwent total arch replacement (TAR) and frozen elephant trunk (FET) implantation. Survival over the follow-up period was evaluated with the Kaplan–Meier survival curve and the log-rank test.ResultsThe median interval time from prior TEVAR to reoperation was 187 days (IQR: 30.0, 1375.0 days). 18.0% of TAAD after TEVAR did not have any obvious symptoms at the time of diagnosis, most of which were found on routine follow-up imaging. The patients in the retrograde group were younger than those in the antegrade group (44.0 ± 9.4 vs. 51.4 ± 10.5 years, P = 0.012). No significant differences in the incidence of post-operative complications or mortality were noted between the two groups. The mean follow-up time was 3 years. No late death or complications occurred after one year following surgery upon follow-up. The asymptomatic survival rate one year after surgery was 90.0%.ConclusionThe TAR and FET technique was feasible and effective for complicated TAAD after TEVAR. The surgical success rate and long-term prognosis of patients undergoing the timely operation are satisfactory.

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Clinical significance of a false lumen pathway through the arch in acute type A aortic dissection and its influence on cervical branch compromise

Cited by 3 publications

References 24 publications

Ultrasonographic detection of chronic type A aortic dissection extending to the right extracranial internal carotid artery: A case report

Ultrasonographic detection of chronic type A aortic dissection extending to the right extracranial internal carotid artery: A case report

CT patterns of acute type A aortic arch dissection: longer, higher, more anterior

Surgical Repair of Two Kinds of Type A Aortic Dissection After Thoracic Endovascular Aortic Repair

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