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At least 217 records · Page 12Linked to original sources
PubMed1994

Acute aortic dissection into a preexisting abdominal aortic aneurysm.

Acute aortic dissection and abdominal aortic aneurysm presenting as coexistent conditions is rare. We report a patient with a history of hypertension and acute severe back pain who had an acute aortic dissection extending into a preexisting 8 cm abdominal aortic aneurysm that was diagnosed by CT scan. There was no evidence of aortic rupture or leakage. The patient was treated with antihypertensive medication for 2 months to allow maturation of the acute dissection prior to elective repair of the abdominal aortic aneurysm. The repair was constructed to allow continued perfusion of both the true and false lumina by fenestration of the aortic septum at the proximal anastomosis. There were no postoperative complications. This case illustrates an unusual combination of aortic diseases. A management plan is described that safely treats both pathologic conditions.

Acute Disease↗
PubMed1997

[Surgery for acute aortic dissection extending to the aortic root using gelatine-resorcine-formol biological glue--a case report].

A 73-year-old woman was admitted with chest pain of sudden onset and hypotension. Enhanced CT showed the dilated ascending aorta with an intimal flap. Emergency surgery was performed under a diagnosis of type A acute aortic dissection and cardiac tamponade. Replacement of the ascending aorta was planned, but during the operation we found that the dissection had extended to the aortic root and that the laceration of the adventitia was located just distal to the aortic annulus. Since the laceration was closer to the aortic annulus than the coronary ostium, it was impossible to reconstruct the aortic stump by classical techniques using Teflon felt strips. Gelatine-Resorcine-Formol (GRF) glue was therefore used to reinforce the proximal aortic stump. We then curved the suture line of the proximal anastomosis so as to resect the laceration while preserving the ostia of the coronary arteries. We were thus able to perform simple replacement of the ascending aorta successfully and the postoperative course was uneventful. By using GRF glue, replacement of the aortic root can be avoided in such cases.

Acute Disease↗
PubMed2005

[Acute aortic dissection].

Acute aortic dissection is a relatively common pathology, which is related to the high incidence of arterial hypertension observed in some population subgroups. It is accompanied by a high mortality rate if not treated immediately. Early diagnosis is relatively simple but depends on a high index of suspicion. Its etiopathogenesis is related to cystic medial necrosis. In the majority of cases, the aortic wall is abnormal along its entire length. Surgery is indicated in virtually all type A dissections, with involvement of the ascending aorta, and in many type B dissections, characterized by isolated involvement of the descending aorta. In the majority of the latter, however, medical therapy appears to lead to better results than surgery, but in recent times, treatment has been revolutionized by the use of stents. Surgery is rarely curative. Hence, long-term follow-up (probably for life) is essential. This includes strict control of arterial hypertension and monitoring of the untreated aortic segments, and especially any residual patent false lumen, which is observed in the majority of cases, in order to prevent rupture and to minimize the consequences of the formation of false aneurysms.

Acute Disease↗
PubMed2001

[Incidence and severity of coronary artery disease in patients with acute aortic dissection: comparison with abdominal aortic aneurysm and arteriosclerosis obliterans].

OBJECTIVES: The incidence and severity of coronary artery disease were studied in patients with acute aortic dissection (AAD), and compared with coronary artery disease in patients with abdominal aortic aneurysm (AAA) or arteriosclerosis obliterans (ASO). METHODS: A total of 71 patients(42 males, 29 females, mean age 61.4 +/- 10.0 years) with AAD, undergoing coronary angiography between 1988 and 1999, were studied including 38 patients with open communication type and 33 patients with thrombosed type. According to the Stanford classification, 18 patients were type A and 53 patients were type B. Patients with AAD following Marfan syndrome or chest trauma were excluded from the study. Selective coronary angiography was performed in age- and sex-matched patients with AAA(n = 57; 42 males, 15 females, mean age 63.9 +/- 4.6 years) or ASO (n = 95; 66 males, 29 females, mean age 62.4 +/- 9.4 years). Coronary artery disease was defined as > or = 75% stenosis (left main trunk lesion of > or = 50% stenosis) by multidirectional imaging. RESULTS: Significant coronary artery disease was demonstrated in 14 patients with AAD (19.7%), 25 patients with AAA (43.9%), and 49 patients with ASO (51.5%). The incidence of coronary artery disease was significantly lower in the AAD group than in the other two groups (p < 0.05). One-vessel disease was present in approximately 70% of the patients with AAD and coronary artery disease. In contrast, multivessel disease was observed in approximately 50% of patients with AAA and ASO. Classification of the patients with AAD according to the blood flow in the false lumen showed coronary artery disease was more highly associated with the thrombosed type [10 (30.3%) of 33 patients] than the open communication type [4 (10.5%) of 38 patients]. Multivariate logistic regression analysis of the patients with AAD showed coronary artery disease was associated with a high serum total cholesterol level (p = 0.025) and the thrombosed type (p = 0.043). CONCLUSIONS: The incidence of coronary artery disease was significantly lower among patients with AAD than among age- and sex-matched patients with AAA or ASO. Coronary artery disease developed in 30% of the patients with the thrombosed type of AAD, although the prognosis seemed to be good.

Acute Disease↗
PubMed2002

[Acute aortic dissection].

OBJECTIVE: Acute aortic dissection is a medical emergency associated with high rates of mortality. Despite recent diagnostic advances, prompt and accurate diagnosis is difficult. We present a review of the a medical emergency service experience to diagnosis, factors associated to prompt diagnosis and inhospital evolution. MATERIAL AND METHOD: We studied 86 consecutive patients who had aortic dissections, to assess the presentation, management, and outcome. RESULTS: Mean age 61.9 +/- 12.5 years, 80% male. Hypertension was the most common predisposing factor (65% of patients overall). Chest pain was the most common initial complaint (58%). The initial clinical impression was aortic dissection in 56% of patients overall. Computed tomography was diagnostic in 96% when used. 62% underwent surgery. Overall in-hospital mortality was 28%. CONCLUSIONS: Acute aortic dissection presents with a wide range of manifestations. A high clinical index of suspicion and a prompt computed tomography should to improve recognition of aortic dissection.

Acute Disease↗
PubMedDate not supplied

Chronic aortic dissection: stenting of aortic true lumen obliteration with late dynamic variations of both lumens.

Percutaneous endovascular techniques were used to treat an arteriovenous fistula (AVF) associated with pancreatic transplantation. A pancreatic transplant superior mesenteric artery-to-superior mesenteric-vein AVF was successfully embolized while flow to the pancreas transplant was preserved. The embolization was aided by the use of Guglielmi detachable coils and a detachable balloon. No complications were encountered. At 23 months follow-up, the patient is doing well with no recurrence.

Aged↗
PubMed1976

Renovascular hypertension and acute aortic dissection in a patient with renal transplant.

The late results of renal transplantation are very encouraging. Apart from the more common complications, such as the rejection phenomenon and recurrent infections, occasionally renovascular hypertension may occur as a late complication. This is, to our knowledge, the first reported case of acute dissecting aortic aneurysm in a young man who had received a renal transplant six years earlier and later developed renovascular hypertension. All patients with renal transplant who develop severe hypertension which is refractory to medical management should be considered for renal arteriogaphy and correction of stenosis, if it is present.

Adult↗
PubMed2000

Stent-graft treatment of type B aortic dissection involving the right aortic arch: case report.

A 56-year-old man suffered from type B aortic dissection associated with the right aortic arch and right descending aorta. The patient was successfully treated by implantation of 2 stent-grafts (a 40-mm Z-stent covered with a 37.5-mm woven Dacron graft) and ligation of the dissected left subclavian artery. A postoperative computed tomographic scan revealed thrombosis of the false lumen and a reduction in the descending aortic diameter.

Aortic Dissection↗
PubMed2002

Acute type A aortic dissection and coarctation of aortic isthmus.

Acute type A aortic dissection and coarctation of the aorta is a rare associated disease. A case of two-stage repair is presented. Firstly the ascending aorta and the right hemi-arch was replaced using deep hypo-thermic circulatory arrest. Cardiopulmonary bypass was proximally instituted, in a patient with total aortic isthmus occlusion, using right axillary artery cannulation. Distally arterial perfusion was obtained cannulating the bilateral hypoplasic femoral arteries. Ten months later a left subclavian artery-descending thoracic aorta bypass was performed.

Aortic Dissection↗
PubMed2004

[Acute aortic dissection 16 months after aortic valve replacement; report of a case].

A 63-year-old man complained of chest pain and back pain 16 months after aortic valve replacement. Computed tomography (CT) showed acute aortic dissection (Stanford A) and we decided to perform operation. We found an entry at aortotomy on operative findings. Under hypothermic circulatory arrest graft replacement of ascending aorta was performed. Postoperative course was uneventful.

Acute Disease↗
PubMed1996

[A case of aortic dissection associated with congenital bicuspid aortic valve].

It is known that bicuspid aortic valve with dilatation of the ascending aorta is one of risk factors of the aortic dissection. A case of acute aortic dissection (DeBakey type-II) associated with bicuspid aortic valve who underwent successfully operation 8 hours after onset is reported. This patient went into cardiogenic shock because of cardiac tamponade and aortic valve regurgitation immediately after onset. Aortic valve and the ascending aorta were replaced using composite graft (#23 SJM prosthetic aortic valve and 26 mm woven Dacron vascular graft) combined with coronary artery reconstruction by Cabrol's technique. Aortic valve showed bicuspid and histological examination revealed cystic medionecrosis and loss of elastic fiber. Postoperative course was uneventful and this patients is doing well 3 years after the operation.

Acute Disease↗
PubMed2005

[Aortic dissection induced by symmetry aortic connector system].

A 74-year-old male with severe triple vessel disease underwent off-pump coronary artery bypass grafting (OPCAB). Preoperative computed tomography (CT) showed severely calcified ascending aorta. We revasculize the left coronary arteries with in situ internal thoracic artery (ITA) graft and the right coronary artery with a saphenous vein graft, which was attached to the disease-free portion of the aortic root, using Symmetry aortic connector system (ACS). Although the operation was uncomplicated, and postoperative course was uneventful until the 5th postoperative day when acute type A aortic dissection occurred. The patient died of aortic rupture on the 7th postoperative day. Necropsy disclosed that the entry located just on the proximal anastomotic site of the vein graft. It is possible placement of ACS device would trigger the dissecting process. With regard to the use of these one-shot devices for diseased aorta, its safety needs further investigation, even though it might be placed on an apparently intact portion.

Aged↗
PubMed2000

[A successful repair of intraoperative retrograde type A aortic dissection in a patient with aortic regurgitation and ascending aortic aneurysm].

The patient was a 67-year-old male with aortic regurgitation and ascending aortic aneurysm. We noticed the type A retrograde aortic dissection occurring from the cannulation site through the right femoral artery. We discontinued cardio-pulmonary bypass immediately, and established selective cerebral perfusion (SCP) eleven minutes after retrograde cerebral perfusion (RCP). We underwent simultaneous aortic valve replacement and ascending and arch graft replacement with an aid of SCP combined with RCP and systemic low flow perfusion. Postoperative course was satisfactory, although patient had a transient neurologic deficit. Intraoperative aortic dissection is a rare but potentially fatal complication. RCP may be a simple and useful method in emergency operation for intraoperative retrograde type A aortic dissection to avoid serious cerebral damage.

Aged↗
PubMed1982

Triple-barrel aorta: dissection of a healed aortic dissection.

An unusual case of a triple-barrel aorta in a 51-year-old woman is described. The patient first had a spontaneous type I dissection of the aorta and acute aortic insufficiency, for which she underwent aortic valve replacement and Dacron graft replacement of the ascending aorta. She remained asymptomatic for five years with a healed aortic dissection (double-barrel aorta) distal to the graft. She then underwent a second operation for repair and poppet replacement of the malfunctioned prosthesis. Postoperative cardiac failure necessitated the use of a counterpulsation intra-aortic balloon catheter, which entered and dissected the wall of the false lumen, thus creating a triple-lumen aorta.

Aortic Dissection↗
PubMed2002

Aortic root replacement with stentless xenograft for aortic dissection.

This paper reviewed aortic root replacement with a stentless xenograft for Stanford Type A aortic dissection. Total aortic arch replacement plus aortic root reconstruction with a stentless xenograft was conducted in 2 patients with acute aortic dissection. In another 2 patients, aortic root replacement with a bioprosthesis was performed for chronic redissection of the aortic root which might be associated with the previous use of gelatin-resorcin-formalin glue. Full root replacement using this device is safe, reliable, reproducible, and technically less demanding. This device also provides a radical option for acute aortic dissection even in patients requiring concomitant aortic arch and root replacement.

Aged↗
PubMed1988

Duplex scanner study of carotid artery dissection following surgical treatment of aortic dissection type A.

In patients suffering from aortic dissection, persistent perfusion of the false lumen distal to the implanted graft is frequent. Postoperative follow-up examinations of the carotid arteries of these patients were performed by duplex scanner and correlated with clinical symptoms. Thirty-nine patients who survived the surgical treatment of acute type A aortic dissection had duplex sonography of both common carotid arteries after an average postoperative follow-up of 53 months. In 21 cases a composite graft and in 18 cases a supracoronary prosthetic vascular graft were implanted. No sign of residual dissection of the common carotid arteries was seen in 23 patients; in nine there was a dissection of both common carotid arteries, and seven patients had a unilateral carotid dissection (five right, two left). There were nine symptomatic patients with the following symptoms: transient ischemic attack (four), amaurosis fugax (four), stroke with incomplete recovery (one). Two symptomatic patients had a corresponding dissection. The generally good prognosis of all these patients suggests a conservative nonoperative treatment.

Aged↗