Predictors of patent false lumen of the aortic arch after hemiarch replacement

Abstract

Brachiocephalic artery dissection and no tear resection are potential predictors of patent false lumen of the aortic arch after hemiarch replacement.

Postoperative care in patients with DeBakey type I aortic dissection: criteria of aortic remodeling and risk factors of disease progression

“…На протяжении многих лет стандартным подходом являлся принцип «primary tear oriented», который предполагает резекцию проксимальной фенестрации и протезирование восходящего отдела аорты по методике открытого дистального анастомоза или протезирования полудуги аорты [9,10]. Однако в настоящее время уже известно, что несмотря на успешное выполнение операции на проксимальных отделах аорты, проходимый ложный канал дистальнее первичной реконструкции сохраняется у 64-90% пациентов, что оказывает крайне неблагоприятное влияние на отдаленные результаты лечения [10][11][12][13][14][15]. Также известно, что одним из ключевых факторов, препятствующих развитию тотального тромбоза ложного канала, являются так называемые резидуальные фенестрации (включающие как дистальные, так и проксимальные, которые не были ликвидированы при первичном хирургическом лечении) [16].…”

Evaluation and Influence of Brachiocephalic Branch Re-entry in Patients With Type A Acute Aortic Dissection

“…recent development of MDCT has allowed detailed evaluations to determine whether the brachiocephalic branches are involved in a dissection. 22 When a brachiocephalic branch is dissected, the branch has a double-barrel lumen, and there has to be a re-entry on the distal side of the branch, although the re-entry often cannot be detected because it is outside of the CT scan range. Patients who have a DeBakey type I aortic dissection usually have several secondary tears in the descending aorta or near the visceral aortic branches; however, such tears have a minimal effect on the patency of the aortic arch false lumen.…”

Successful Embolization Therapy through Reentry Tear in the Right Subclavian Artery for Treating Patent False Lumen in the Aortic Arch Formed after Type A Dissection Repair

“…Many studies have mentioned that patent FLs and non-resection of primary entries are potential predictors of late aortic dilatation. 1 , 4 , 5 ) In previous AAAD cases, an intimal tear has been found in the ascending aorta in more than 60%, arch in 13%–30%, and descending aorta in 6% of cases. Additionally, multiple tears have been found in 8%–10% of cases, whereas 3% of cases have not shown any tear.…”

“…Such dilatation after AAAD repair has been reported to occur in approximately 40% of patients. 1 , 4 ) Kimura et al have reported that the rate of surgical reintervention (involving thoracic endovascular aneurysm repair) to the aortic arch after AAAD repair is 7.8%, 5 ) and Preventza et al have reported that the mortality rate of traditional open surgery is 11.7%. 3 ) In practice, distal dilatation can cause many problems, which may result in inoperable as well as sudden death cases associated with aortic events.…”

“…Perioperative mortality and morbidity are lower with HAR than TAR; however, HAR is associated with the potential risk of dilatation of the remaining aortic arch. 1 , 2 ) Upon postoperative enlargement of the remaining aortic arch, redo-TAR can be considered as a next surgical procedure, 1 , 3 ) which has an extremely high mortality rate. 3 ) Therefore, other less invasive treatments are required for these clinical states.…”