Management of Acute Aortic Syndrome and Chronic Aortic Dissection

Nordon, Ian M.; Hinchliffe, Robert J.; Loftus, Ian; Morgan, Robert; Thompson, Matt

doi:10.1007/s00270-010-0028-3

Cited by 37 publications

(54 citation statements)

References 63 publications

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“…During systole, the dissected aorta system experiences very high WSS that is up to 89 Pa; while, during diastole, the WSS becomes much lower: the maximum WSS over this period is approximately 5 Pa. The highest WSS occurs near the entries, implicating the vulnerability of these positions to be further split; in fact, by decreasing the arterial shear stress, one can minimize the propagation of the dissection [43,44]. …”

Section: Resultsmentioning

confidence: 99%

A patient-specific study of type-B aortic dissection: evaluation of true-false lumen blood exchange

et al. 2013

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BackgroundAortic dissection is a severe pathological condition in which blood penetrates between layers of the aortic wall and creates a duplicate channel – the false lumen. This considerable change on the aortic morphology alters hemodynamic features dramatically and, in the case of rupture, induces markedly high rates of morbidity and mortality.MethodsIn this study, we establish a patient-specific computational model and simulate the pulsatile blood flow within the dissected aorta. The k-ω SST turbulence model is employed to represent the flow and finite volume method is applied for numerical solutions. Our emphasis is on flow exchange between true and false lumen during the cardiac cycle and on quantifying the flow across specific passages. Loading distributions including pressure and wall shear stress have also been investigated and results of direct simulations are compared with solutions employing appropriate turbulence models.ResultsOur results indicate that (i) high velocities occur at the periphery of the entries; (ii) for the case studied, approximately 40% of the blood flow passes the false lumen during a heartbeat cycle; (iii) higher pressures are found at the outer wall of the dissection, which may induce further dilation of the pseudo-lumen; (iv) highest wall shear stresses occur around the entries, perhaps indicating the vulnerability of this region to further splitting; and (v) laminar simulations with adequately fine mesh resolutions, especially refined near the walls, can capture similar flow patterns to the (coarser mesh) turbulent results, although the absolute magnitudes computed are in general smaller.ConclusionsThe patient-specific model of aortic dissection provides detailed flow information of blood transport within the true and false lumen and quantifies the loading distributions over the aorta and dissection walls. This contributes to evaluating potential thrombotic behavior in the false lumen and is pivotal in guiding endovascular intervention. Moreover, as a computational study, mesh requirements to successfully evaluate the hemodynamic parameters have been proposed.

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Section: Resultsmentioning

confidence: 99%

A patient-specific study of type-B aortic dissection: evaluation of true-false lumen blood exchange

et al. 2013

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“…[81][82][83][84][85][86] Reintervention rates of 7.2% and mortality rates of 11.4% reported within 12 months of initial successful thoracic aortic endovascular procedures highlight the importance of close clinical and imaging follow-up in this cohort of patients. 85 Patients with type B IMH or PAU who present without rupture or imaging features that suggest high risk of rupture can be successfully treated conservatively.…”

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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“…There is now a reasonably robust body of evidence to support the assertion that endovascular repair of chronic dissections may be achieved with mortality rates below 5% and a low incidence of neurological complications, even in complicated cases. 88,188 In the previously mentioned systematic review, the median length of follow up was 26 months. The all cause mortality rate was 9.2%.…”

Section: Endovascular Repairmentioning

confidence: 99%