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At least 37 records · Page 2Linked to original sources
PubMed1976

Repair in arterial tissue. Electron microscopy of Evans blue vital stained embolectomy catheter lesion of the rabbit thoracic aorta.

The rabbit thoracic aorta was studied by EM and vital staining with Evans blue at vaired points of time after a single lesion produced by an embolectomy catheter. EM of white areas: the surface cells of the myo-intimal thickening resembled endothelial cells with a discrete occurrence of microfilaments inside the plasma-membranes and rather differentiated flap-like junctions. EM of blue areas: the surface cells resembled modified smooth muscle cells with a heavily contrasted zone just inside the luminal plasma membrane containing closely packed microfilaments. The cell contacts either were missing, or they presented undifferentiated side-to-side contacts.

Animals↗
PubMed2005

Endovascular stent graft for symptomatic mobile thrombus of the thoracic aorta.

Mobile thoracic aortic thrombus is a potential source of arterial embolism. Therapeutic management remains controversial. Systemic anticoagulation and various open surgical procedures are the commonly used therapeutic modalities. We report the successful primary treatment by endovascular stent graft of a mobile thoracic aortic thrombus that had caused visceral and peripheral embolism. Our case shows that endovascular stent-graft treatment is an effective, minimally invasive treatment of symptomatic mobile thoracic aortic thrombus.

Aged↗
PubMed1991

[Estimation of atherosclerotic lesions in the thoracic aorta by transesophageal echocardiography].

The thoracic aorta is one of the portions frequently involved with atherosclerotic lesions. We estimated atherosclerotic lesions in the thoracic aorta in consecutive 137 patients (59 +/- 10 years old) using transesophageal echocardiography. The study population consisted of 60 with coronary artery disease (CAD), 36 with hypertension (HT), 28 with hypercholesterolemia (HC, total cholesterol greater than or equal to 230 mg/dl), eight with dissecting aneurysm, nine with true aneurysm and two with aortitis syndrome. We used a single transverse scan-plane probe with ultrasound frequency of 5 MHz. We could obtain satisfactory echograms of whole thoracic aorta except upper portion of the ascending aorta. We defined atherosclerotic lesions as an increased echo-density of the intima, protruded plaque, ulceration or aneurysm. Atherosclerotic lesions were observed in 71 of 137 patients (52%). High incidence of the atherosclerotic lesions was seen in patients with HT (72%), HC (57%) and CAD (57%), whereas incidence of atherosclerotic lesions was low (15%) in patients without HT, HC, CAD or aortic aneurysm. Atherosclerotic lesions were observed more frequently in patients aged greater than or equal to 60 years (69% vs 34%, p less than 0.001). In patients with HT or HC, atherosclerotic lesions were frequently observed even in patients younger than 60 years old (HT: 58%, HC: 53%). We concluded that HT, HC and aging were important risk factors for the atherosclerotic process in the thoracic aorta, and transesophageal echocardiography was a useful approach for the detailed estimation of atherosclerotic lesions in the thoracic aorta.

Adolescent↗
PubMedDate not supplied

Subtle or atypical injuries of the thoracic aorta and brachiocephalic vessels in blunt thoracic trauma.

Aortic or brachiocephalic vessel injuries secondary to blunt thoracic trauma are relatively common and can occur throughout the length of the thoracic aorta or in various locations in the brachiocephalic vessels. Aortography remains the standard of reference for the diagnosis of these injuries despite recent technologic advances in other imaging modalities. The classic aortographic finding in aortic or brachiocephalic vessel injury consists of a large false aneurysm, typically protruding from the medial aspect of the aortic isthmus. However, intrathoracic aortic or brachiocephalic vessel injury can and does occur at any intrathoracic location and may exhibit a wide variety of radiographic appearances, thereby presenting a diagnostic challenge even for experienced trauma angiographers. Large false aneurysms may appear oval or rounded, tubular, or asymmetrically globular and may manifest in unusual locations such as the ascending aorta. Although smaller, irregularly shaped false aneurysms at atypical locations may be obscure or mimic ductus diverticula, their irregular, sharp margins allow them to be distinguished as injuries. The subtlety of aortic or brachiocephalic vessel injuries necessitates a high degree of suspicion along with meticulous imaging technique in all cases and the use of additional projections in equivocal cases for definitive diagnosis.

Adult↗
PubMed2000

[Application of spiral computerized tomography in the study of traumatic lesions of the thoracic aorta].

PURPOSE: Acute thoracic aortic injuries account for up to 10-20% of fatalities in high-speed deceleration road accidents and have an estimated immediate fatality rate of 80-90%. Untreated survivors to acute trauma (10-20%) have a dismal prognosis: 30% of them die within 6 hours, 40-50% die within 24 hours, and 90% within 4 months. We investigated the diagnostic accuracy of Helical Computed Tomography (Helical CT) in acute traumatic injuries of the thoracic aorta, and the role of this technique in the diagnostic management of trauma patients with a strong suspicion of aortic rupture. MATERIAL AND METHODS: We compared retrospectively the chest Helical CT findings of 256 trauma patients examined June 1995 through August 1999. All patients underwent a plain chest radiograph in supine recumbency when admitted to the Emergency Room. Chest Helical CT examinations were performed according to trauma score, to associated traumatic lesions and to plain chest radiographic findings. All the examinations were performed with no intravenous contrast agent administration and the pitch 2 technique. After a previous baseline study, contrast-enhanced scans were acquired with pitch 1 in 87 patients. All examinations were assessed for the presence of mediastinal hematoma, periaortic hematoma, traumatic pseudodiverticulum, irregular aortic wall or contour and intimal flap as signs of aortic rupture. RESULTS: Helical CT showed thoracic aortic lesions in 9 of 256 patients examined. In all the 9 cases we found a mediastinal hematoma and all of them had positive plain chest radiographic findings of mediastinal enlargement. Moreover, in 6 cases aortic knob blurring was also evident on plain chest film and in 5 cases depressed left mainstem bronchus and trachea deviation rightwards were observed. All aortic lesions were identified on axial scans and located at the isthmus of level. Aortic rupture was always depicted as pseudodiverticulum of the proximal descending tract and intimal flap. We also found periaortic hematoma in 6 cases and intramural hematoma in 1 case. There were no false positive results in our series: 7 patients with Helical CT diagnosis of aortic rupture were submitted to conventional aortography that confirmed both type and extension of the lesions as detected by Helical CT, and all findings were confirmed by gross inspection at surgery. No false negative results have been recorded so far: untreated aortic ruptures are fatal within 4 months in 90% of patients, or they may evolve into chronic pseudoaneurysm in about 5% of survivors. CONCLUSIONS: In our experience Helical CT had much higher diagnostic sensitivity and specificity than plain chest radiography. In agreement with larger published series, in our small one the diagnostic accuracy of Helical CT was 100% in the evaluation of traumatic aortic ruptures. Moreover, Helical CT is faster and less invasive than conventional aortography, which makes this diagnostic modality increasingly used and markedly improves the management of the serious trauma patient. The more widespread use of this diagnostic tool has permitted to standardize the technique and now Helical CT can be used not only as a screening modality for patients that undergo digital aortography, but also as a reliable diagnostic method for surgical planning.

Adolescent↗
PubMed2002

Critical decisions in trauma of the thoracic aorta.

Trauma to the thoracic aorta is a significant injury with a high mortality. This mortality is partly due to the delayed recognition of the condition. The increase of motor vehicle accidents and the use of firearms worldwide has resulted in an increase of the incidence of trauma to the thoracic aorta. Certain new developments in diagnosis and management have resulted in traditional methods being questioned. This review analyses current literature and data which we attempt to evaluate.

Aorta, Thoracic↗
PubMed1992

Anatomic and radiologic bases of surgery of the thoracic aorta.

Lesions of the thoracic aorta create problems related to their site and relations with the main aortic branches. The aim of surgery must be to treat the lesion while ensuring perfusion of the tissues excluded by clamping during the operation. Anatomic study of the aortic lesions is based on imaging. Angiography is still often the basic examination though it shows only the lumen and course of the aorta. However, CT and MRI visualise the aortic wall and especially the relations of the aorta to the mediastinal structures. A comparison of anatomic and imaging studies was made on 10 fresh subjects coming from the anatomy department of the Saints-Pères and from the school of surgery of Fer à Moulin. Sections were made every 3 to 5 mm in 3 planes (sagittal, coronal and axial) after CT localisation of the plane of section. This anatomic study was correlated with CT and MR images made on healthy volunteers. The choice of surgical management of a lesion of the thoracic aorta is based on preoperative anatomic assessment by imaging applied not only to the aorta but also to its branches and the territory supplied.

Aorta, Thoracic↗
PubMed1989

Penetrating atherosclerotic ulcers of the thoracic aorta.

Penetrating ulcer of the thoracic aorta is defined as an atherosclerotic lesion of the descending thoracic aorta with ulceration that penetrates the internal elastic lamina, allowing hematoma formation in the media. There is controversy whether this lesion differs from classic acute type III aortic dissection, based on its location, radiographic findings, natural history, and recommended therapeutic approach. Of 47 patients with a diagnosis of aortic dissection seen at our hospital during a 2-year period, five patients had clinical and radiographic findings of penetrating ulcer. Each of the five patients had characteristic computerized tomographic (CT) findings and two patients had angiographic confirmation. In all patients CT showed subintimal hemorrhage, aortic wall enhancement, absence of a double lumen, and contrast extravasation through the ulceration. In both patients who underwent angiography, ulceration, subintimal hematoma, and absence of a false lumen were demonstrated. The clinical presentation in four patients simulated acute aortic dissection or expanding thoracic aneurysm. The other patient, who was normotensive, did not have symptoms referable to the thoracic aorta but was studied because of an abnormal chest x-ray film. None of these five patients required surgical intervention. All five patients were alive and free of symptoms at 6 months, 8 months, 14 months (two patients), and 30 months after the original diagnosis. Follow-up CT scans in four patients showed resolution of subintimal hematoma and some dilatation of the lumen but no progression to rupture or aneurysm. Other authors stress the importance of differentiating symptomatic penetrating atherosclerotic ulcers from acute type III aortic dissection because of the higher incidence of rupture of penetrating ulcers and therefore recommend early surgical intervention.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed2006

Results of endovascular repair of the thoracic aorta with the Talent Thoracic stent graft: the Talent Thoracic Retrospective Registry.

BACKGROUND: Endovascular treatment of thoracic aortic diseases demonstrated low perioperative morbidity and mortality when compared with conventional open repair. Long-term effectiveness of this minimally invasive technique remains to be proven. The Talent Thoracic Retrospective Registry was designed to evaluate the impact of this therapy on patients treated in 7 major European referral centers over an 8-year period. METHODS: Data from 457 consecutive patients (113 emergency and 344 elective cases) who underwent endovascular thoracic aortic repair with the Medtronic Talent Thoracic stent graft (Medtronic/AVE, Santa Rosa, Calif) were collected. Follow-up analysis (24 +/- 19.4 months, range 1-85.1 months) was based on clinical and imaging findings, including all adverse events. To ensure consistency of data interpretation and event reporting, one physician reviewed all adverse events and deaths for the whole cohort of patients. In the case of discrepancies, the treating physicians were queried. FINDINGS: Among 422 patients who survived the interventional procedure (in-hospital mortality 5%, 23 patients), mortality during follow-up was 8.5% (36 patients), and in 11 of them the death was related to the aortic disease. Persistent endoleak was reported at imaging follow-up in 64 cases: 44 were primary (9.6%) and 21 occurred during follow-up (4.9%). Seven patients with persistent endoleak had aortic rupture during follow-up, at a variable time from 40 days to 35 months, and all subsequently died. A minor incidence of migration of the stent graft (7 cases), graft fabric alteration (2 cases), and modular disconnection (3 cases) was observed at imaging. Kaplan-Meier overall survival estimate at 1 year was 90.97%, at 3 years was 85.36%, and at 5 years was 77.49%. At the same intervals, freedom from a second procedure (either open conversion or endovascular) was 92.45%, 81.3%, and 70.0%, respectively. CONCLUSION: Endovascular treatment for thoracic aortic disease with the Talent stent graft is associated with low early morbidity and mortality rates also for patients who are at high risk and treated on an emergency basis. Follow-up data indicate a substantial durability of the procedure with a high freedom from related death and secondary interventions.

Adult↗
PubMed1997

Intramural hematoma of the thoracic aorta: precursor sign to thoracic aortic dissection.

A 60-year-old man was admitted at his local hospital for persistent chest pain and suspicion of aortic dissection. No evidence of aortic dissection or intimal disruption was noted by means of computed tomography and transesophageal echocardiography. A localized intramural hematoma of the ascending aorta was found. He was first treated medically and remained asymptomatic for 8 days when he developed a new episode of chest pain. He was found to have an acute type A dissection by computed tomography. He underwent graft replacement of the ascending aorta and had an uneventful post-operative course. This case report describes the development of true aortic dissection in a patient who previously had a localized intramural hematoma.

Aortic Dissection↗
PubMed1996

Traumatic rupture of the descending thoracic aorta.

Traumatic rupture of the descending thoracic aorta is a highly lethal injury caused by sudden, rapid deceleration in high-speed motor vehicular collisions and falls from heights. Deceleration causes the mobile ascending aorta and aortic arch to move forward while the descending thoracic aorta remains fixed by the mediastinal pleura. This opposing movement creates a tear at the aortic isthmus just distal to the origin of the left subclavian artery. Patients with traumatic ruptured descending thoracic aortas often have serious multisystem injuries, and approximately 85% of these patients die at accident scenes or during emergency department resuscitation. The most frequent cause of death is free rupture of periaortic tissues that temporarily have provided tamponade to the sites of aortic ruptures. Surgical mortality rates for patients who survive initial resuscitation are between 10% and 25%. Advances in field triage and emergency medical transportation systems and new preoperative evaluation modalities have improved the survival of patients with traumatic descending thoracic aorta ruptures.

Adult↗
PubMed1983

The ultrastructural basis of the permeability of arterial endothelium to horseradish peroxidase. Freeze-fracture and tracer studies of rat thoracic aorta and basilar artery.

The thoracic aorta and basilar artery, in which the incidence of atherosclerosis is known to be different, were examined to elucidate the correlation between the structure of the intercellular cleft junction between adjacent endothelial cells and its permeability to HRP. Tannic acid or HRP in the vessel lumen passed through the intercellular clefts of the thoracic aorta into the subendothelial space, whereas in the basilar artery they were unable to penetrate beyond the tight junction of the intercellular clefts. Freeze-fracture replicas revealed that the tight junctions of the thoracic aorta consisted of one to two junctional strands in most areas of the cleaved planes, with discontinuities in some places, whereas those of the basilar artery consisted of a continuous belt-like meshwork of six anastomosing junctional strands on average. These observations confirm that the structure of endothelial junctions in arteries has a close correlation with the permeability of the intercellular clefts to HRP.

Animals↗
PubMed1997

Localised thrombus in the distal aortic arch: its aetiology analysed by three-dimensional mould model of the thoracic aorta.

Isolated thrombus of the thoracic aorta without aneurysmal change or dissection is a relatively rare event. A case presenting with aortic thrombus and successive distal embolism is reported herein and the aetiology of the thrombus of the distal aortic arch is analysed by a three dimensional aortic model. A 61-year-old man suffered acute ischaemia in his right leg on January 26, 1994. Enhanced computed tomography (CT) showed a localized thrombus in the distal aortic arch expanding towards the descending aorta, and partial infarction of the left kidney and the spleen. Angiography demonstrated abrupt occlusion of the right superficial femoral artery. Immediate anticoagulation with heparin and coumadin was administered, and the thrombus in the aorta disappeared following 1 month of this medical treatment, leaving the renal and splenic infarction unchanged. The unresolved occlusion of the superficial femoral artery and the popliteal artery was treated with a bypass from the right superficial femoral artery to the peroneal artery using a reversed saphenous vein graft. The mould model of the thoracic aorta was reconstructed from CT, and the thrombus was found to be at the most distal and medial site of the lesser curvature of the aortic arch. This specific location is referred mostly as the site for thrombus formation in the literature. The case is reported briefly and the risk of this specific region of the thoracic aorta for thrombus formation is discussed using this mold model.

Angiography↗