Importance of false lumen thrombosis in type B aortic dissection prognosis

Trimarchi, Santi; Tolenaar, Jip L.; Jonker, Frederik H.W.; Murray, Brian; Tsai, Thomas T.; Eagle, Kim A.; Rampoldi, Vincenzo; Verhagen, Hence J.M.; Herwaarden, Joost A. van; Moll, Frans L.; Muhs, Bart E.; Elefteriades, John A.

doi:10.1016/j.jtcvs.2012.11.048

Cited by 157 publications

(128 citation statements)

References 18 publications

(25 reference statements)

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“…35,76 A number of factors have been associated with a greater risk of aortic dilation and adverse outcomes in patients treated conservatively for uncomplicated Type B aortic dissections (Table 4). [76][77][78][79] Patients who develop complications, including disease progression, contained rupture, and renal and mesenteric ischaemia often require more invasive management. 35,36,80 However, patients who undergo surgery for these indications have a high rate of morbidity with a reported risk of paraplegia of 19% and mortality of 31%.…”

Section: Acute Aortic Syndrome Risk Factors and Clinical Presentationmentioning

confidence: 99%

The role of multidetector-row CT in the diagnosis, classification and management of acute aortic syndrome

Abbas¹,

Brown²,

Peebles³

et al. 2014

BJR

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The term "acute aortic syndrome" (AAS) encompasses several non-traumatic life-threatening pathologies of the thoracic aorta presenting in patients with a similar clinical profile. These include aortic dissection, intramural haematoma and penetrating atherosclerotic ulcers. These different pathological entities can be indistinguishable on clinical grounds alone and may be confused with other causes of chest pain, including myocardial infarction. Multidetector-row CT (MDCT) is the current modality of choice for imaging AAS with a sensitivity and specificity approaching 100%. Early diagnosis and accurate radiological classification is associated with improved clinical outcomes in AAS. We review the characteristic radiological features of the different pathologies that encompass AAS and highlight the vital role of MDCT in determining the management of these life-threatening conditions.

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Section: Acute Aortic Syndrome Risk Factors and Clinical Presentationmentioning

confidence: 99%

The role of multidetector-row CT in the diagnosis, classification and management of acute aortic syndrome

Abbas¹,

Brown²,

Peebles³

et al. 2014

BJR

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“…4). This flow can even work like a pressure-loaded valve, causing an increase of the pressure in the proximal blind end of the false lumen and lead to an acceleration of aneurysm growth [13,14]. To avoid such a development, the stent (or at least its distal portion) has to be anchored within the single aortic lumen after resecting the dissection membrane (Fig.…”

Section: Discussionmentioning

confidence: 99%

Open aortic arch surgery in chronic dissection with visceral arteries originating from different lumens

Urbanski

Bougioukakis

Deja

et al. 2015

Eur J Cardiothorac Surg

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OBJECTIVES: Surgical management of chronic aortic dissection is controversial, especially when the dissection extends into the abdominal aorta in which the visceral arteries originate from different lumens and is combined with aortic arch pathology necessitating surgery. The aim of the study was to evaluate the results of open surgery in this complex aortic pathology. METHODS:Between June 2002 and 2015, a total of 17 patients (median age 57, range 32-76 years) necessitating complete arch replacement presented complex chronic dissection of the thoraco-abdominal aorta with the visceral arteries originating from different lumens. Fourteen patients (82%) had had previous cardiac surgery, which was performed on the proximal aorta in all but one because of acute type A dissection. Nine patients without considerable dilatation of the descending aorta received aortic arch replacement with distal resection of the dissection membrane, and 8 patients with progressive dilatation of the thoracic aorta underwent aortic arch and descending aorta replacement via clamshell approach. RESULTS:No early (defined as 30-day, 90-day and in-hospital period) deaths, strokes or spinal cord injuries occurred. Only 1 patient (6%) presented temporary neurological dysfunctions (delirium, agitation), which resolved completely before discharge, and an injury of the recurrent laryngeal nerve was documented in 2 patients (12%). Temporary dialysis was necessary in 1 case. The follow-up was complete for all patients. All but one patient, who died due to leukaemia 23 months after surgery, were alive at the last follow-up (median duration 33 months, range 2-118 months). No patient needed a reoperation or an intervention on the thoracic and/or abdominal aorta. Moreover, no noticeable progression of the chronic dissection in the downstream aorta was documented in any patient. CONCLUSIONS:The results after conventional aortic arch repair with distal resection of the dissection membrane and, if necessary, with replacement of the progressively dilated chronic dissected thoracic aorta can offer excellent results in experienced hands and, therefore, this technique may be considered as a preferable option for surgical treatment of chronic aortic dissection with involvement of the aortic arch and the visceral arteries originating from different lumens.

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“…31,36 A thrombosed false lumen was newly enhanced in 3 cases at 1 year in our study, which indicated a risk of possible future rupture. 31, 36 We therefore recommend regular follow-up CT examinations to evaluate the risk of rupture, such as false lumen enhancement and increased arterial diameter. 6,9,37,38…”

Section: Etiology Of Icadmentioning

confidence: 99%

Impact of Noninvasive Conservative Medical Treatment for Symptomatic Isolated Celiac Artery Dissection

Ichiba

Hara

Yunoki

et al. 2016

Circ J

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Background: There is no definite consensus regarding the management of symptomatic isolated celiac artery dissection (ICAD), and the effect of conservative medical treatment has never been evaluated. Methods and Results:We enrolled 13 consecutive symptomatic ICAD patients without signs of arterial rupture between 2006 and 2015. All patients received noninvasive conservative medical treatment. The epidemiology, radiological findings and prognostic effect of conservative medical treatment on outcomes were retrospectively assessed. ICAD usually developed in middle-aged men around 50 years old who had a history of smoking. The patients typically presented with acute continuous epigastric pain at rest and with abdominal tenderness on physical examination. On enhanced computed tomography at presentation, the false lumen was found to be double-barreled in 2 patients (15.4%), partially thrombosed in 1 (7.7%), and completely thrombosed in 10 (76.9%). Dissection of associated branches was found in the left gastric artery in 1 patient (7.7%), common hepatic artery in 5 (38.5%), and splenic artery in 7 patients (53.8%). Malperfusion was not found in the stomach or liver but was found in the spleen in 4 patients (30.8%). During a median follow-up period of 376 (165-602) days, all patients were alive without any antiplatelet, anticoagulant, endovascular or surgical treatment.Conclusions: Symptomatic ICAD without arterial rupture can be safely treated with conservative medical therapy over the short term. (Circ J 2016; 80: 1445 -1451

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Importance of false lumen thrombosis in type B aortic dissection prognosis

Cited by 157 publications

References 18 publications

The role of multidetector-row CT in the diagnosis, classification and management of acute aortic syndrome

The role of multidetector-row CT in the diagnosis, classification and management of acute aortic syndrome

Open aortic arch surgery in chronic dissection with visceral arteries originating from different lumens

Impact of Noninvasive Conservative Medical Treatment for Symptomatic Isolated Celiac Artery Dissection

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