Prognosis for Patients With Type B Acute Aortic Dissection  Risk Analysis of Early Death and Requirement for Elective Surgery

Fan

et al. 2018

Sci Rep

The purpose of this study is to evaluate the hemodynamic characteristics of the true lumen (TL) and the false lumen (FL) in 16 patients with aortic dissection (AD) using 4D flow magnetic resonance imaging (MRI) and thoracic and abdominal computed tomography (CT) angiography. The quantitative parameters that were measured in the TL and FL included velocity and flow. The mean area and regurgitant fraction of the TL were significantly lesser at all four levels (p < 0.05); the average through-plane velocity, peak velocity magnitude, average net flow, peak flow, and net forward volume in the TL were considerably higher (p < 0.05). The intimal entry’s size was negatively correlated with the blood flow velocity and flow rate in the TL (p < 0.05) and positively correlated with the average through-plane velocity, average net flow, and peak flow in the FL (p < 0.05); the blood flow indices in the TL were enhanced with an increase in the intimal entry numbers (p < 0.05) and the peak flow in the FL was lowered (p = 0.025); if FL thrombosis existed, the average through-plane velocity and peak velocity magnitude in the TL were substantially higher (p < 0.05). 4D flow MRI facilitates qualitative and quantitative analysis of the alterations in the abdominal aortic blood flow patterns.

Section: Introductionmentioning

confidence: 99%

Quantitative Study of Abdominal Blood Flow Patterns in Patients with Aortic Dissection by 4-Dimensional Flow MRI

Fan

et al. 2018

Sci Rep

Journal of Vascular Surgery

“…Hata et al 20 reported on 180 type B dissection patients during a mean follow-up of 51 months. Patients were primarily managed medically except for complicated disease, and they discovered four (2.2%) cases of NTAD.…”

Section: Discussionmentioning

confidence: 99%

New type A dissection after acute type B aortic dissection

Charlton-Ouw

Sandhu

Leake

et al. 2018

The natural history of ATBD is such that there is a persistent risk of NTAD, with the highest risk in the first 6 months. Factors associated with NTAD include bicuspid aortic valve and young age. Thoracic endovascular aortic repair did not have a large effect on risk. Timely diagnosis and repair of NTAD are associated with good survival rates. Lifelong surveillance is warranted in all cases of descending thoracic aortic dissection regardless of initial treatment modality.

“…The incidence of complications is closely correlated with the surgeon’s skill and advanced endovascular equipment. 12 Therefore, EVAR treatment should be carried out in highly specialized vascular centres where the requirement can be met to routinely perform open and endovascular procedures. This would help to cope with accidents in an effective and timely manner.…”

Section: Discussionmentioning

confidence: 99%

Treatment of serious complications following endovascular aortic repair for type B thoracic aortic dissection

et al. 2017

ObjectiveThis study aimed to describe treatment of serious complications after primary thoracic endovascular aortic repair (TEVAR) in type B aortic dissection.MethodsFrom June 2008 to March 2016, serious complications occurred in 58 patients without Marfan syndrome who received TEVAR for type B aortic dissection.ResultsComplications included endoleak, distal true lumen collapse, retrograde dissection, stroke, stent–graft (SG) migration and mistaken deployment, lower limb ischaemia, and SG fracture. Treatment included endovascular repair, surgical procedures, or conservative medication. Forty-six patients recovered from complications. Twelve patients were not cured. The median follow-up time was 29.5 months (2–61 months). The overall 30-day mortality rate was 1.7% (1/58) and the total mortality rate following secondary complications was 8.6% (5/58). The causes of death were stroke and aortic rupture.ConclusionSome treatments need to be performed after TEVAR because of severe complications. A reduction in these complications can be achieved by optimal evaluation of patients, selection of SGs, and specialized endovascular manipulation.