Early entry closure for acute type B aortic dissection by open stent grafting

Uchida, Naoshige; Katayama, Akira; Tamura, Kentaro; Miwa, Soichi; Murao, Naoki; Kuraoka, Masatsugu

doi:10.1007/s11748-010-0749-x

Cited by 7 publications

(4 citation statements)

References 15 publications

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“…When selecting the FET size, a size of 90% of the aortic outer diameter was selected if the true lumen was displaced into the false cavity and the exact diameter could not be determined 5) ; if the true lumen size was preserved, a size 2-3 mm larger than the diameter measured from the circumference of the true lumen was chosen. Ultimately, the size was determined using a transesophageal echo and sizer during surgery.…”

Section: Methodsmentioning

confidence: 99%

Surgical Strategies for Type B Aortic Dissection by Frozen Elephant Trunk

Matsuzaki

Yamasaki

Hohri

et al. 2019

Annals of Vascular Diseases

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The timing and choice of surgical method for type B aortic dissection, is still a topic of much debate. We performed total arch replacement using frozen elephant trunk (TAR-FET) as a means of preventing distant aortic events, such as retrograde type A aortic dissection (RTAD). We conducted analysis of 142 patients with acute type B dissection who were admitted between January of 2010 and July of 2017. Fifty-five cases required surgical intervention to treat enlargement of the false lumen diameter and ULP formation 2 weeks after the onset of symptoms. 17 TAR-FET were performed with a mean of 42±26 days period from onset to surgery. There were no complications of RTAD or paraplegic, and 90% of patient demonstrated aortic event free survival (5 years) and false lumen reduction ratio of 35%. Based on our analysis, using TAR-FET properly avoids serious complications like RTAD, and is a viable treatment option for type B dissection. (This is a translation of

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Section: Methodsmentioning

confidence: 99%

Surgical Strategies for Type B Aortic Dissection by Frozen Elephant Trunk

Matsuzaki

Yamasaki

Hohri

et al. 2019

Annals of Vascular Diseases

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“…A study regarding FET surgery for acute complicated Type B dissection did not also primarily involve patients with rupture. 1316,1357 Adjuncts for surgery under left thoracotomy include deep hypothermic circulatory arrest and distal aortic perfusion. The former is more likely to be selected when proximal extension of dissection makes proximal aortic cross-clamping distal to Zone 2 difficult/impossible/highly risky.…”

Section: Malperfusionmentioning

confidence: 99%

JCS/JSCVS/JATS/JSVS 2020 Guideline on Diagnosis and Treatment of Aortic Aneurysm and Aortic Dissection

Ogino,

Iida,

Akutsu

et al. 2023

Circ J

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▋ 1.3.2 Location of AneurysmsAneurysms are classified into thoracic, thoracoabdominal, and abdominal aneurysms, which are further classified as follows: Thoracic: It is further classified into ascending, arch, and descending aortic aneurysms. Thoracoabdominal: The Crawford classification based on the range of replacement in thoracoabdominal aneurysm surgery (Figure 5). Abdominal: Abdominal aortic aneurysms are classified using the renal artery as the reference into the supra-and infra-renal segments. ▋ 1.3.3 CauseBased on the cause of the aneurysm, aortic aneurysms are classified into atherosclerotic, traumatic, inflammatory, infected, congenital, etc. Most of them are atherosclerotic aortic aneurysms. Advance Publication13 JCS/JSCVS/JATS/JSVS 2020 Guideline on Diagnosis and Treatment of Aortic Aneurysm and Aortic Dissection is indicated for saccular aneurysms regardless of the size of the thickening (See PQ 1). Inflammatory aortic aneurysm: Aneurysm caused by inflammation. Although, in general, "inflammation" is a concept that includes infection, however, inflammatory aortic aneurysm does not include the aortic aneurysm with infection. Inflammatory periaortitis: A case with inflammation around the aorta but with less aortic dilation that does not meet the criteria of aneurysm. Infected aortic aneurysm: Aneurysm caused by infection. Rupture: Extravascular blood leakage due to damage to the arterial wall. Impending rupture: The absence of damage to the arterial wall despite the presence of aneurysmal pain. ▋ 4.2 Aortic DissectionDissecting aneurysm: Aortic dissection with aneurysmal formation. A general term that was previously used for overall aortic dissection. However, because in many cases with aortic dissection in acute phase does not meet the criteria for an aneurysm, aortic dissection in acute phase is now called, "acute aortic dissection." True lumen: The original arterial cavity. False lumen: A new cavity formed in the arterial wall (the term "dissection cavity" is not appropriate). Dissection flap: The (intima-media) septal wall. It used to be called "intimal dissection." However, it actually consists of intima and a part of the media. Tear: Intimal and medial tears of aortic dissection which is the site of communication between the true lumen and the false lumen. "Intimal tear" is also regularly used as a synonym for "tear". Entry: A site where blood flow enters from the true lumen to the false lumen. Re-entry: A site where blood flow enters from the false lumen to the true lumen. ("communication window" that is also used as a term for both entry and re-entry) Aortic dissection with patent false lumen: It is a synonym for "communicating aortic dissection", a type of aortic dissection in Europe classification. It is also called "classic dissection" or "double barrel aorta." One of the three types of aortic dissection in Japanese Aortic dissection with thrombosed false lumen: It is a synonym for "noncommunicating aortic dissection", a type of aortic dissection in Europe classification. One of the three ty...

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“…Furthermore, the discrepancy between the proximal diameter with an undissected aorta and the distal diameter with a collapsed true lumen sometimes requires a stent graft of the tapering type. The OSG allows effective management of arch vessels with abundant atherosclerotic plaque, dilatation of the ascending aorta, and annuloaortic ectasia [49]. However, TEVAR might be able to achieve better results in difficult cases in the future with the progress in stent-graft materials.…”

Section: Entry Closure Using the Osg For Type B Aortic Dissectionmentioning

confidence: 99%

Open stent grafting for complex diseases of the thoracic aorta: clinical utility

Uchida

2012

Gen Thorac Cardiovasc Surg

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Open stent grafting is an alternative treatment for extensive thoracic aortic replacement. However, this procedure is associated with a high incidence of spinal cord injury, which has limited its application. Multiple factors have been suggested to explain the risk of spinal cord injury, including deep delivery of the stent graft, history of operation of the downstream aorta, and postoperative low blood pressure. Cerebrospinal fluid drainage or a hybrid operation in combination with trans-femoral thoracic stent grafting is useful for preventing spinal cord injury. Open stent grafting remains an alternative treatment for atherosclerotic aneurysms with dilatation of the ascending aorta. Open stent grafting for acute aortic dissection is effective for remodeling of the false lumen. The graft diameter for aortic dissection should be 90 % of the total diameter of the aorta, and the distal landing zone should be limited to the T7 vertebral level to prevent new intimal tears or spinal cord injury. Open stent grafting seems a feasible bailout strategy for the treatment of retrograde aortic dissection after TEVAR for type B aortic dissection. Newly designed devices for open stent grafts include the Matsui-Kitamura stent graft or branched open stent graft, which is produced in Japan. The effectiveness of open stent grafting in the treatment of Marfan syndrome remains unclear. A commercially available device for open stent grafting would be desired in Japan. In conclusion, an open stent graft remains an alternative treatment for complex thoracic aortic pathologies.

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Early entry closure for acute type B aortic dissection by open stent grafting

Abstract: Early entry closure for both complicated and uncomplicated acute type B aortic dissection with an open stent graft has an acceptable early outcome and provides a high aortic remodeling rate.

Cited by 7 publications

References 15 publications

Surgical Strategies for Type B Aortic Dissection by Frozen Elephant Trunk

Surgical Strategies for Type B Aortic Dissection by Frozen Elephant Trunk

JCS/JSCVS/JATS/JSVS 2020 Guideline on Diagnosis and Treatment of Aortic Aneurysm and Aortic Dissection

Open stent grafting for complex diseases of the thoracic aorta: clinical utility

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