Comparison of Diagnostic and Therapeutic Value of Transesophageal Echocardiography, Intravascular Ultrasonic Imaging, and Intraluminal Phased-Array Imaging in Aortic Dissection With Tear in the Descending Thoracic Aorta (Type B)

Bartel, Thomas; Eggebrecht, Holger; Müller, Silvana; Gutersohn, Achim; Bonatti, Johannes; Pachinger, Otmar; Erbel, Raimund

doi:10.1016/j.amjcard.2006.08.022

Cited by 37 publications

(26 citation statements)

References 14 publications

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“…The success of TEVAR is critically dependent on high-quality, accurate imaging before, during, and after stent-graft placement. 199 Although invasive catheter-based angiography ( Figure 14) is the method of first choice for the guidance of aortic stent-graft placement, 42 TEE offers definite advantages in the hands of an experienced examiner, 59,60,62,200,201 TEE is particularly useful in the operating room and provides contributions at various phases of the procedure. In patients with type B aortic dissection, guidewire advancement and positioning can be guided by both fluoroscopy and TEE.…”

Section: Use Of Imaging Procedures To Guide Endovascularmentioning

confidence: 99%

“…After endovascular stent graft implantation, IVUS also enables dynamic evaluation of the success of the procedure. 200,[202][203][204] Angiography, TEE, and IVUS are used for evaluating the expansion of stent grafts, verification of branch anastomosis and the beginning of false lumen thrombosis, and reevaluation of improved malperfusion. During a procedure, TEE may be superior for assessing retrograde type A dissection and can provide immediate information on left ventricular function.…”

Section: Use Of Imaging Procedures To Guide Endovascularmentioning

confidence: 99%

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Multimodality Imaging of Diseases of the Thoracic Aorta in Adults: From the American Society of Echocardiography and the European Association of Cardiovascular Imaging

Goldstein

Evangelista

Abbara

et al. 2015

Journal of the American Society of Echocardiography

526

434

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Section: Use Of Imaging Procedures To Guide Endovascularmentioning

confidence: 99%

Section: Use Of Imaging Procedures To Guide Endovascularmentioning

confidence: 99%

Multimodality Imaging of Diseases of the Thoracic Aorta in Adults: From the American Society of Echocardiography and the European Association of Cardiovascular Imaging

Goldstein

Evangelista

Abbara

et al. 2015

Journal of the American Society of Echocardiography

526

434

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“…[85][86][87] Accurate deployment of the stent-graft requires endovascular experience 88 and may be assisted by blood pressure and pulse regulation. 88,89 When introduction challenges are encountered, an antegrade approach via the brachial artery might offer a solution to snare a guidewire in the aorta.…”

Section: Chronic Treatmentmentioning

confidence: 99%

Update in the management of type B aortic dissection

et al. 2016

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Stanford type B aortic dissection (TBAD) is a life-threatening aortic disease. The initial management goal is to prevent aortic rupture, propagation of the dissection, and symptoms by reducing the heart rate and blood pressure. Uncomplicated TBAD patients require prompt medical management to prevent aortic dilatation or rupture during subsequent follow-up. Complicated TBAD patients require immediate invasive management to prevent death or injury caused by rupture or malperfusion. Recent developments in diagnosis and management have reduced mortality related to TBAD considerably. In particular, the introduction of thoracic stent-grafts has shifted the management from surgical to endovascular repair, contributing to a fourfold increase in early survival in complicated TBAD. Furthermore, endovascular repair is now considered in some uncomplicated TBAD patients in addition to optimal medical therapy. For more challenging aortic dissection patients with involvement of the aortic arch, hybrid approaches, combining open and endovascular repair, have had promising results. Regardless of the chosen management strategy, strict antihypertensive control should be administered to all TBAD patients in addition to close imaging surveillance. Future developments in stent-graft design, medical therapy, surgical and hybrid techniques, imaging, and genetic screening may improve the outcomes of TBAD patients even further. We present a comprehensive review of the recommended management strategy based on current evidence in the literature.

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“…Entry tear was considered proximal when located in the upper part of the ascending aorta or arch in an operated type A dissection or at the proximal part of a type B dissection. Entry tear size was quantified by the maximum diameter of the tear by TEE by use of longitudinal and transverse views 18,19 ( Figure 2). In cases where the entry tear was not visualized by TEE, it was measured by CT. 20,21 Interobserver variability of maximum entry tear diameter was analyzed in 20 cases in which TEE was repeated with an interval shorter than 1 month by 2 different and blinded echocardiographers from our department.…”

Section: Imaging Variablesmentioning

confidence: 99%

Long-Term Outcome of Aortic Dissection With Patent False Lumen

Evangelista

Saldierna²,

Ribera³

et al. 2012

Circulation

341

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Background— Patent false lumen in aortic dissection has been associated with poor prognosis. We aimed to assess the natural evolution of this condition and predictive factors. Methods and Results— One hundred eighty-four consecutive patients, 108 surgically treated type A and 76 medically treated type B, were discharged after an acute aortic dissection with patent false lumen. Transesophageal echocardiography was performed before discharge, and computed tomography was performed at 3 months and yearly thereafter. Median follow-up was 6.42 years (quartile 1 to quartile 3: 3.31–10.49). Forty-nine patients died during follow-up (22 type A, 27 type B), 31 suddenly. Surgical or endovascular treatment was indicated in 10 type A and 25 type B cases. Survival free from sudden death and surgical-endovascular treatment was 0.90, 0.81, and 0.46 (95% CI, 0.36–0.55) at 3, 5, and 10 years, respectively. Multivariate analysis identified baseline maximum descending aorta diameter (hazard ratio [HR]: 1.32 [1.10–1.59]; P =0.003), proximal location (HR: 1.84 [1.06–3.19]; P =0.03), and entry tear size (HR: 1.13 [1.08–1.2]; P <0.001) as predictors of dissection-related adverse events, whereas mortality was predicted by baseline maximum descending aorta diameter (HR: 1.36 [1.08–1.70]; P =0.008), entry tear size (HR: 1.1 [1.04–1.16]; P =0.001), and Marfan syndrome (HR: 3.66 [1.65–8.13]; P =0.001). Conclusions— Aortic dissection with persistent patent false lumen carries a high risk of complications. In addition to Marfan syndrome and aorta diameter, a large entry tear located in the proximal part of the dissection identifies a high-risk subgroup of patients who may benefit from earlier and more aggressive therapy.

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Comparison of Diagnostic and Therapeutic Value of Transesophageal Echocardiography, Intravascular Ultrasonic Imaging, and Intraluminal Phased-Array Imaging in Aortic Dissection With Tear in the Descending Thoracic Aorta (Type B)

Cited by 37 publications

References 14 publications

Multimodality Imaging of Diseases of the Thoracic Aorta in Adults: From the American Society of Echocardiography and the European Association of Cardiovascular Imaging

Multimodality Imaging of Diseases of the Thoracic Aorta in Adults: From the American Society of Echocardiography and the European Association of Cardiovascular Imaging

Update in the management of type B aortic dissection

Long-Term Outcome of Aortic Dissection With Patent False Lumen

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