Computed tomography angiography of aorta subjected to external wrapping

Płonek, Tomasz; Dumański, Andrzej; Nowicki, Rafał; Kustrzycki, Wojciech

doi:10.1186/s13019-016-0487-y

Cited by 9 publications

(7 citation statements)

References 20 publications

(23 reference statements)

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“…Therefore, this aortic complication may also be excluded, when the internal diameter of the periaortic hematoma is larger than the diameter of the vascular prosthesis used for wrapping. [23] In our patients, this image was also detected at various diameters around the grafts.…”

Section: Discussionsupporting

confidence: 57%

Surgical treatment with wrapping of the moderately-dilated ascending aorta

Kaya

Çolak

Ceviz

et al. 2018

Turk Gogus Kalp Dama

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Bu çalışmada çıkan aort dilatasyonunun wrapping tekniği ile tedavisinin erken ve orta dönem sonuçları sunuldu. Ça lış m a pla nı: Ocak 2010-Şubat 2017 tarihleri arasında çıkan aort dilatasyonu nedeniyle wrapping tekniği uygulanan toplam 54 hasta (16 erkek, 38 kadın; ort. yaş: 56.9±12.7 yıl; dağılım 21-77 yıl) retrospektif olarak incelendi. Tüm hastalarda Dacron greftler kullanıldı. Wrapping, tüm hastalarda diğer kardiyak cerrahi işlemler ile birlikte uygulandı. Wrapping 32 hastada aortoplasti ile birlikte, 22 hastada ise izole olarak yapıldı. Ameliyat öncesi klinik bulgular, eşlik eden kardiyak sorunlar, ameliyat sırası parametreler, ameliyat sonrası erken ve uzun dönem sonuçları değerlendirildi. Çıkan aort ve inen aort çapları, ejeksiyon fraksiyonu, sol ventrikül diyastol sonu ve sistol sonu çapları, cerrahi sonrası bilgisayarlı tomografi veya transtorasik ekokardiyografi kullanılarak ölçüldü ve ameliyat sonrası değerler ile karşılaştırıldı. Bul gu lar: Ortalama takip süresi 3.8 (dağılım 1-7) yıl idi. Hastaların hiçbirinde wrapping işlemi ile ilişkili ameliyat sırası komplikasyon gözlenmedi. Bir hasta ameliyat sonrası erken dönemde kaybedildi. Bir hastada ise, ameliyat sonrası serebral infarkt, relapssız intraarteriyel fibrinolizis ile sekelsiz olarak düzeltildi. İki hastada kanama nedeni ile diğer iki hastada ise sternal dehisens nedeniyle revizyon gerekti. Ameliyat sonrası aort çaplarında küçülme ve ejeksiyon fraksiyonunda artış istatistiksel olarak anlamlı idi. Takip sırasında sinüs Valsalva ve distal aort dilatasyonu, rüptür, pseudoanevrizma ve greft mobilizasyonu gibi bulgulara rastlanmadı. So nuç: Çalışma sonuçlarımız, çıkan aort replasmanı gerektirmeyen orta derece aort dilatasyonu olan hastalarda wrapping tekniğinin güvenli bir şekilde uygulanabileceğini göstermektedir.

show abstract

Section: Discussionsupporting

confidence: 57%

Surgical treatment with wrapping of the moderately-dilated ascending aorta

Kaya

Çolak

Ceviz

et al. 2018

Turk Gogus Kalp Dama

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“…The mesh is fully and intimately incorporated due to its macroporous and pliant nature. The appearances seen with low porosity vascular grafts on CT imaging [14] are not seen with the clinical use of the mesh as has been shown on repeated imaging for what is now 333 patient years of follow-up.…”

Section: Caveat Emptor!mentioning

confidence: 90%

“…Wrapping, however, was not completely set aside [1,[12][13][14]. The material placed around the aorta has been referred to as 'external grafting' [15], 'wrapping' [1], and 'girdling' [9] providing a 'jacket' [16] 'sleeve' [17] or 'corset' [12].…”

Section: Adult Cardiacmentioning

confidence: 99%

Support of the aortic wall: a histological study in sheep comparing a macroporous mesh with low-porosity vascular graft of the same polyethylene terephthalate material

Hoof

Verbrugghe

Verbeken

et al. 2017

Interactive CardioVascular and Thoracic Surgery

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OBJECTIVES: Wrapping with various materials was an early treatment for aortic aneurysms. Wrapping with low-porosity vascular grafts has been associated with graft migration and vascular erosion. An alternative is to use a macroporous mesh (MPM) made of the same polymer (polyethylene terephalate). We compared the histological outcome 1 year after wrapping sheep aortas with low-porosity grafts versus MPM fabrics. METHODS:The 2 different fabrics were wrapped around the aorta of 3 sheep. After 1 year the aortas were excised. The 2 wrapped segments of aorta were compared with each other and control aorta. Histological examinations and measurements were made of the layers of the aortic wall in 36 prespecified locations in each of the 3 sheep.RESULTS: Both fabrics were consistently surrounded by foreign body reaction and well-vascularized fibrosis. This was more pronounced with the low-porosity vascular graft material which was poorly incorporated and caused buckling at the transition between wrapped and unwrapped aorta. Conversely, the MPM was fully incorporated, resulting in a composite mesh/biological aortic wall. There was reduction of medial thickness with both materials but it was locally more extreme due to the corrugations in the vascular graft material. The findings were consistent between sampled locations and were similar in the 3 animals. CONCLUSIONS:The different porosity and rigidity of the materials influences their incorporation into the aortic wall. The incorporation of the pliable MPM precludes the complications of migration and erosion which are seen after wrapping with low-porosity prosthetic vascular graft material.

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“…This reverse remodeling of the aorta becomes evident immediately after the operation, and it persists over time. In a recent study by Plonek et al, the maximum diameter of the aorta decreased by 39%, from an average value of 50.5 mm down to 30.7 mm (24). The final diameter of the AA was, on average, 4.5 mm shorter than the diameter of the vascular prosthesis what had been used.…”

Section: Biomechanical Effectsmentioning

confidence: 99%

Wrapping of the ascending aorta revisited—is there any role left for conservative treatment of ascending aortic aneurysm?

González-Santos

Arnáiz-García

2017

J. Thorac. Dis.

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Dilatation of the ascending aorta (AA) is a common finding in patients with aortic valve disease.The clinical practice guidelines recommend replacing the AA whenever the diameter exceeds 45 mm.However, no consensus has been reached regarding the approach when the aorta is only moderately dilated.Although the risk in aorta replacement is generally low, it may be higher when associated with other complex surgical procedures or it is carried out in elderly patients or patients with significant comorbidity. This would justify the use of alternative surgical techniques, which reduce surgical risk and guarantee a durable correction of the aortic pathology. Conservative treatment of aneurysms of the AA via wrapping with different synthetic materials has been implemented for many years. The most commonly used technical variant is wrapping the dilated aorta with a vascular prosthesis with a predetermined diameter. When this technique is adequately applied, it immediately reduces the diameter of the AA and, to a lesser degree, the diameter of the aortic root and arch, while at the same time it reinforces the weak aortic wall. These effects lead to a drop-in wall shear stress and in the risk of aortic dissection and rupture, and persist over time. Although the low elasticity of the external support causes significant changes in the histologic structure of the aortic wall, mainly atrophy and alterations typical of a foreign body-induced reaction, this does not seem to involve a higher risk of complications. In some selected patients, this technique may be used in cases other than post-stenotic aortopathy, and also in aortas with a larger diameter.

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Computed tomography angiography of aorta subjected to external wrapping

Cited by 9 publications

References 20 publications

Surgical treatment with wrapping of the moderately-dilated ascending aorta

Surgical treatment with wrapping of the moderately-dilated ascending aorta

Support of the aortic wall: a histological study in sheep comparing a macroporous mesh with low-porosity vascular graft of the same polyethylene terephthalate material

Wrapping of the ascending aorta revisited—is there any role left for conservative treatment of ascending aortic aneurysm?

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