Intramural Hematoma of the Ascending Aorta; Diagnosis, Management and Outcome

Czerny, Martin; Schmidli, Jürg

doi:10.1007/978-1-4471-5622-2_17

Cited by 5 publications

(6 citation statements)

References 19 publications

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“…The recent American Heart Association guidelines on aortic disease management as well as a recent European expert consensus on aortic arch pathology each gave a Class I indication to use of multidisciplinary aortic teams. 2,17 A recent Canadian Clinical Practice Update has also endorsed the need for an Aortic Team model and collaborative decision pathways for aortic care. 18 Still, despite the theoretic practicality of an Aortic Team and its potential value for patient care, reports to the formal development of an Aortic Team and clinical results derived from such a model are sparse.…”

Section: Discussionmentioning

confidence: 99%

The Aortic Team Model for the Management of the Distal Arch, Descending Thoracic and Thoracoabdominal Aorta: Appraisal at 3 Years

McClure,

Rommens,

Herget

et al. 2023

Aorta (Stamford)

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Background This study aimed to assess feasibility, logistical challenges, and clinical outcomes associated with the implementation of an Aortic Team model for the management of distal arch, descending thoracic and thoracoabdominal aortic disease. Methods An Aortic Team care pathway was implemented in November 2019. Working as a unit, two cardiac surgeons, two vascular surgeons, an interventional radiologist, a cardiologist, and an anesthesiologist collectively determined care decisions via multispecialty presence at an Aortic Clinic. Cardiac and vascular surgeons operated in tandem for open procedures. Interventional radiology participated alongside cardiac and vascular for endovascular procedures. Cardiology aided in medical therapies for heritable and degenerative disease, and had a lead role for genetics and high-risk pregnancy referrals. The model spanned three hospitals. Clinical outcomes at 3 years were assessed. Results There were 35 descending thoracic and thoracoabdominal surgeries and 77 thoracic endovascular aortic repairs. Endoarch devices were used in 7 cases (Gore Thoracic Branch Endoprosthesis, 4, Terumo RelayBranch, 3) and an endothoracoabdominal device in 4 cases (Cook Zenith t-branch). The Aortic Clinic acquired 456 patients, with yearly increases (54 patients [year 1], 181 patients [year 2], 221 patients [year 3]). For surgery, mortality was 8.6% (3/35), permanent paralysis 5.7% (2/35), stroke 8.6% (3/35), permanent dialysis 0%, and reinterventions 8.6% (3/35). For endovascular cases, mortality was 3.9% (3/77), permanent paralysis 3.9% (3/77), stroke 5.2% (4/77), permanent dialysis 1.3% (1/77), and reinterventions 16.9% (13/77). Conclusion An Aortic Team model is feasible and ensures all treatment options are considered. Conventional open thoracoabdominal procedures showed acceptable outcomes. Endoarch technology shows early promise.

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Section: Discussionmentioning

confidence: 99%

The Aortic Team Model for the Management of the Distal Arch, Descending Thoracic and Thoracoabdominal Aorta: Appraisal at 3 Years

McClure,

Rommens,

Herget

et al. 2023

Aorta (Stamford)

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“…It is now the preferred approach for the treatment of aneurysms of the descending thoracic aorta, due to its reduced morbidity, hospital length of stay, and short-term mortality compared to open thoracic aneurysm repair [98] . Although TEVAR was developed for the treatment of aneurysmal disease, treatment indications now include complicated type B aortic dissection, intramural hematoma, penetrating aortic ulcer, and traumatic aortic lesions [98,99] . Recently, developments have been made for endovascular ascending aortic and aortic arch repair.…”

Section: Tee For Endovascular Surgery On the Aortamentioning

confidence: 99%

Transesophageal echocardiography during surgery of the thoracic aorta in adults

Alberts,

Eberl,

Hermanns

2023

Vessel Plus

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Thoracic aortic surgery poses significant challenges due to the complex anatomy and potential for life-threatening complications. Transesophageal echocardiography (TEE) has emerged as a crucial imaging tool in the management of patients undergoing these operations. TEE offers real-time, high-resolution imaging of the heart and aorta, enabling accurate assessment of aortic pathology, evaluation of cardiac function, and monitoring of intraoperative hemodynamics. Its semi-invasive nature, immediate availability, and ability to provide dynamic information make TEE an indispensable adjunct during these intricate procedures. One of the primary indications for TEE during thoracic aortic surgery is the assessment of aortic pathology, including aneurysms, dissections, and aortic valve diseases. TEE allows precise visualization of the extent, location, and severity of aortic lesions, facilitating decision-making regarding repair strategies, graft sizing, and intraoperative guidance. Furthermore, TEE aids in identifying associated cardiac abnormalities such as valvular or ventricular dysfunction, which may impact surgical planning and outcomes. This review aims to summarize the current evidence supporting the use of TEE during thoracic aortic surgical interventions and highlight its invaluable contributions to perioperative patient care.

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“…Revascularizing the LSA is therefore recommended through the transposition on the left common carotid artery (LCCA) or, more commonly, through the bypass between the two. 1 Alternatively, new endovascular devices 2,3 allow TEVAR and LSA revascularization via a single-branched thoracic stent graft. As the published data on carotid-subclavian bypass implantation serve as a reference for future endovascular prostheses for the same pathologies, it was our study's aim to analyze and publish this procedure's outcome data.…”

Section: Introductionmentioning

confidence: 99%

Outcome of Revascularizing the Left Subclavian Artery via Carotid-Subclavian Bypass

Rylski,

Matzdorf,

Kondov

et al. 2023

Thorac Cardiovasc Surg

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Background Endovascular thoracic aortic treatment frequently requires extending the proximal landing zone up into the aortic arch with consecutive covering of the left subclavian artery orifice. Our aim was to report on our outcome of left subclavian artery revascularization using carotid-subclavian bypass via lateral access to the subclavian artery. Methods Patients' charts in our aortic center were screened for all those who had undergone carotid-subclavian bypass during endovascular thoracic aortic repair procedures. We analyzed perioperative complications such as cervical plexus nerve or phrenic nerve injury, bleeding, and primary and follow-up graft patency. Results Between 2001 and 2020, 118 patients underwent carotid-subclavian bypass implantation. Postoperative complications included left-sided stroke in 3% and axillary, phrenic, and recurrent laryngeal nerve palsy in 3, 2, and 3%, respectively. Carotid-subclavian bypass–related death rate was 0%. Bypass patency was 92 ± 7% at 5 years. We documented nine (8%) bypass late occlusions with one left upper extremity ischemia and one late stroke due to an embolized thrombus formed at the bypass anastomosis. All others were asymptomatic. Conclusion Carotid-subclavian bypass surgery is associated with very low risk of death, stroke, or any nerve palsy. Lateral access to the left subclavian artery reduces the risk of phrenic nerve injury.

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Intramural Hematoma of the Ascending Aorta; Diagnosis, Management and Outcome

Cited by 5 publications

References 19 publications

The Aortic Team Model for the Management of the Distal Arch, Descending Thoracic and Thoracoabdominal Aorta: Appraisal at 3 Years

The Aortic Team Model for the Management of the Distal Arch, Descending Thoracic and Thoracoabdominal Aorta: Appraisal at 3 Years

Transesophageal echocardiography during surgery of the thoracic aorta in adults

Outcome of Revascularizing the Left Subclavian Artery via Carotid-Subclavian Bypass

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