Search Results (9)

Background: The treatment of thoraco-abdominal aortic aneurysms (TAAAs) and chronic type B aortic dissections (TAAD), is technically challenging. Traditional open surgery repair carries high morbidity and mortality rates, while endovascular repair is limited by anatomical constraints. This study investigates the safety and effectiveness of a hybrid approach in high-risk patients with TAA disease and complex renal and hypogastric anatomy. Methods: This was a retrospective single-center study, including all consecutive patients with TAAA and TAAD with complex renal and/or hypogastric artery anatomy treated with a hybrid approach between 2020 and 2024 in a high-volume aortic center. Primary endpoint was technical success. Secondary endpoints were early complications, overall and aortic-related mortality, aortic-related reintervention, the incidence of endoleaks, and the target vessel (TV) patency and TV instability at 30-day and during follow-up. Results: During the study period, a total of 92 patients with TAAA or TAAD were treated at our institution. Five high-risk patients (5.4%) with complex renal/hypogastric artery anatomy underwent open renal debranching and hypogastric revascularization followed by staged endovascular repair with custom-made double fenestrated/branched device. Technical success was achieved in all cases with no intra-operative mortality. No spinal cord ischemia or 30-day mortality occurred. Target vessel patency at 30 days was 90%. At a median follow-up of 38 months (IQR 26–49 months), there were no cases of aortic-related death. Conclusions: Hybrid repair is a feasible and effective option for managing complex TAAA and TAAD in high-risk patients. Larger studies with longer follow-up are needed to better define the clinical role of this approach. Full article

Chronic type B aortic dissection (cTBAD) is a challenging condition frequently complicated by persistent false lumen (FL) perfusion, leading to aneurysmal degeneration. Despite significant advances in thoracic endovascular aortic repair (TEVAR), long-term management remains challenging because of continuous FL backflow from distal re-entry tears and progressive aortic dilatation. We present the first documented case of FL exclusion using a custom-made false lumen occlusion device (FLOD). A 77-year-old male who had undergone TEVAR in 2017 underwent computed tomography angiography (CTA) in 2025, with the results revealing aneurysmal degeneration of the descending thoracic aorta (maximum diameter 58.5 mm) and two distal re-entry tears with substantial FL perfusion. Following multidisciplinary evaluation, the patient underwent endovascular reintervention with proximal stent graft extension and the deployment of a custom FLOD into the FL via femoral access. Completion angiography confirmed proper FL exclusion with preservation of visceral artery patency. Transesophageal echocardiography demonstrated rapid FL thrombosis. The patient was discharged on postoperative day 5 in good condition without complications. This case highlights that combining endograft extension with a dedicated FLOD is a safe and effective strategy for selected patients with complex cTBAD anatomy. Full article

Objective: Type B aortic dissection is a life-threatening medical condition. Endovascular closure of the primary entry by means of TEVAR is considered, nowadays, the gold standard if operative treatment is necessary. The aim of this study is to analyse the theoretical applicability of selective endovascular entry sealing using different occluder systems. Methods: A CT-graphic analysis of 102 patients who received TEVAR from January 2017 to June 2023 was performed. Patients with an intramural haematoma were excluded. The study patients were divided in two groups: type B aortic dissection (n = 87) and distal stent graft-induced new entry (n = 15). The TBAD group included patients with acute (n = 63), subacute (n = 12), and chronic aortic dissections (n = 12). The CTA analysis of the location, length, and width of the entry was performed using Aquarius iNtuition (TeraRecon, Inc., Foster City, CA, USA). After completion of the data collection, the possible application of all three occluder systems (ASD-Occluder, Septal-Occluder, and Amplatzer™-Occluder) was analysed, with reference to the Instructions for Use. Results: The ASD-Occluder from GORE is produced in five different sizes. It can be used in 81.4% (n = 83) of all patients in the overall study, including 82.8% TBAD (n = 72) and 73.3% of dSINE (n = 11) patients. When using the ASD-Occluder, 10.3% (n = 9) of patients are expected to have complete vascular coverage of the LSA based on our CTA analysis. The Septal-Occluder from GORE is offered in three different sizes. Complete entry closure can theoretically be achieved in fifty patients (57.5%) with TBAD and in nine patients (60%) with dSINE, based on CTA analysis and IFU criteria. With the use of the Septal-Occluder, 3.9% (n = 4) of the dSINE patients and 4.6% (n = 4) of the TBAD patients were expected to have complete aortic branch occlusion. The Amplatzer™-Occluder from Abbott is provided in 27 different sizes to effectively seal defects with a diameter of 4 to 56 mm. It can technically be used in 90.1% of patients (n = 92), of which 89.7% with TBAD (n = 78) and 93.3% with dSINE (n = 14) to completely seal the entry. Conclusions: CTA analysis in patients with TBAD and dSINE demonstrated that by the theoretical application of occluder systems, a seal of the entry would be achieved in 57.8% to 90.1% of the patients. However, in addition to entry closure, the use of occluder systems can also lead to unintentional partial (10.7–23.5%) or complete (3.9–22.5%) coverage of adjacent aortic branches. The clinical significance and applicability of the occluder system should be reviewed in future studies and practical applications to evaluate safety, efficacy, and possible complications in order to define the benefit–risk balance. Full article

Background: Minimally Invasive Staged Segmental Artery Coil Embolization (MIS²ACE) is a novel technique of spinal cord preconditioning used to reduce the risk of paraplegia in thoracoabdominal aortic aneurysm (TAAA) repair. In this study, we report our experience with MIS²ACE, including both degenerative and post-dissection TAAA, while we attempt to systematically summarize relevant data available in the literature. Design: single-center observational study with systematic review of the literature and meta-analysis. Methods: Initial retrospective analysis of 7 patients undergoing MIS²ACE over 12 sessions with a subsequent systematic review of the literature and meta-analysis of the available published data (PROSPERO protocol number: CRD42023477411). Baseline patient and aneurysm characteristics, along with procedural technique and outcomes, were analyzed. One-arm pooling of proportions was used to summarize available published data. Results: We treated seven patients (5 males, 71%) with a median age of 69 years (IQR 55,69). According to the Crawford classification, five patients (1%) had extent II TAAA, and two (29%) had extent III TAAA. Five patients (71%) had post-dissection -TAAA; four of them were after Stanford type A dissection, and one had a chronic type B dissection. Three patients (43%) had connective tissue disease. Of the seven patients, six (86%) underwent previous aortic surgery, while the median aneurysm diameter was 58 mm (IQR 55,58). MIS²ACE was successful in 11 sessions (92%). The median number of embolized arteries was 4 (IQR 1,4). There were no periprocedural complications in any embolization. The median embolization-operation time interval was 37.0 days (IQR 31,78). Two patients had open and five endovascular treatment. There were no events of spinal cord ischemia either after MIS²ACE or after the aortic repair. Out of the 432 initially retrieved articles, we included two studies in the meta-analysis, including patients with MIS²ACE for spinal cord preconditioning in addition to our cohort. The prevalence of pooled postoperative spinal cord ischemia among MIS²ACE patients is 1.9% (95% CI −0.028 to 0.066, p = 0.279; 3 studies; 81 patients, 127 coiling sessions). Conclusions: While the current published data is limited, our study further confirms that MIS²ACE is a technically feasible and safe option for spinal cord preconditioning. Full article

The aim of this study is to investigate the applicability of the dual-venc (DV) 4D flow magnetic resonance imaging (MRI) to quantify the complex flow patterns in type B aortic dissection (TBAD). One GRAPPA-accelerated single-venc (SV) and one compressed-sensing (CS) accelerated DV 4D flow MRI sequences are used to scan all subjects, including twelve chronic TBAD patients and two volunteers. The scans are performed twice for the reproducibility assessment of the scan protocols. Voxelwise quantitative flow parameters including kinetic energy (KE), peak velocity (PV), forward and reverse flows (FF, RF) and stasis are calculated. High-venc (HV) data from the DV acquisition are separately analyzed. The scan time reduction by the CS-accelerated DV 4D flow MRI acquisition is 46.4% compared with the SV acquisition. The DV velocity-to-noise ratio (VNR) is higher compared with HV (p = 0.000). No true lumen (TL) parameter shows a significant difference among the acquisition types (p > 0.05). The false lumen (FL) RF is higher in SV compared with the DV acquisition (p = 0.009). The KE is higher (p = 0.038) and stasis is lower (p = 0.01) in HV compared with SV acquisition. All FL parameters except stasis are higher and stasis is lower in HV compared with DV acquisition (p < 0.05). Positive Pearson correlations among the acquisition types in TL and high agreements between the two scans for all acquisition types are observed except HV RF in the FL, which demonstrates a moderate agreement. The CS-accelerated DV 4D flow MRI may have utility in the clinical daily routine with shortened scan times and improved velocity measurements while providing high VNR in TBAD. The observed hemodynamic flow trends are similar between GRAPPA-accelerated SV and CS-accelerated DV 4D flow MRI acquisitions; however, parameters are more impacted by CS-accelerated HV protocol in FL, which may be secondary to the CS regularization effects. Full article

Background. The frozen elephant trunk technique has become popular and led to an expansion of indications for surgery. Various hybrid grafts for the frozen elephant trunk are used, sometimes with significantly different features. The objective of this study was to compare early- and mid-term outcomes after the frozen elephant trunk for aortic dissection using different hybrid grafts. Methods. The prospective study included 45 patients with acute/chronic aortic dissections. The patients were randomized into two groups. Group 1 patients (n = 19) were implanted with a hybrid graft E-vita open plus (E-vita OP). Group 2 (n = 26) included patients who received a MedEng graft. The inclusion criteria were type A and type B acute and chronic aortic dissection. The exclusion criteria were as follows: hyperacute aortic dissection (less than 24 h), organ malperfusion, oncology, severe heart failure, stroke, and acute myocardial infarction. The primary endpoint was early- and mid-term mortality. The secondary endpoints were postoperative complications (stroke and spinal cord ischemia, myocardial infarction, respiratory failure, acute renal injury, and re-operation for bleeding). Results. The rate of stroke and spinal cord ischemia in the E-vita OP vs. MedEng groups was 11% vs. 4% (p = 0.565) and 11% vs. 0% (p = 0.173), respectively. The respiratory failure rate was comparable in both groups (p > 0.999). Acute kidney injury requiring hemodialysis and the need for re-sternotomy in the MedEng group vs. E-vita OP group was 31% vs. 16% (p = 0.309) and 15% vs. none (p = 0.126), respectively. Early mortality in the MedEng and E-vita OP groups did not differ (8% vs. 0, p = 0.501). The mid-term survival in the analyzed groups was 79% vs. 61%, (p = 0.079), respectively. Conclusions. No statistically significant differences were observed between patients receiving frozen elephant trunk with the hybrid MedEng and E-vita OP grafts in regard to early mortality and morbidity. Mid-term survival was also non-significant between analyzed groups with a trend toward more favorable mortality in the MedEng group. Full article

Chronic type B aortic dissection (cTBAD) is a rare but challenging condition that requires individual treatment strategies. Especially the long-term therapy impacts prognosis. In this single-center retrospective study, we evaluated patients with cTBAD in our vascular outpatient clinic over 10 years. Follow-up consultations included contrast-enhanced, electrocardiogram-triggered, high-resolution CT angiography (CTA) covering the entire aorta. Evaluated characteristics went beyond demographic characteristics combining the treatment approach and the timing and occurrence of potential complications. We analyzed 133 patients in total (n = 92, 69.2% male) with cTBAD with a mean follow-up of 67.7 months. Most of them underwent invasive treatment (n = 102, 76.7%), the majority received thoracic endovascular aortic repair (TEVAR) (n = 82, 61.7%). A total of 80 patients (60.2%) had major complications, whereas over a third was free of complications even after 5 years. Most common complications were progress of dissection and endoleaks, aneurysms of true (TL) and false lumen (FL) were more common in the later time periods. The treatment of cTBAD in terms of timing, therapy approach, and complications is still challenging for the entire aortic team. Nevertheless, the early recognition of complications permits promising treatment options and highlights the importance of frequent follow-up examinations especially within the first years. Full article

Cardiovascular disease (CVD) represents the most important cause of mortality and morbidity worldwide. There is heterogeneity in the epidemiology and management of CVD between male and female patients. In the specific case of acute aortic dissection (AAD), women, at the time of diagnosis, are older than men and complain less frequently of an abrupt onset of pain with delayed presentation to the emergency department. Furthermore, a history of hypertension and chronic obstructive pulmonary disease is more common among women. In type A AAD, women more often experience pleural effusion and coronary artery compromise, but experience less neurological and malperfusion symptoms. They undergo less frequent surgical treatment and have higher overall in-hospital mortality. Conversely, in type B AAD no significant differences were shown for in-hospital mortality between the two genders. However, it should be highlighted that further studies are needed in order to develop AAD gender specific preventive, diagnostic and therapeutic strategies. Full article

Aortic dissection (AD) causes more deaths each year in the United Kingdom than road traffic collisions. Yet the incidence of AD is not known. The management of acute type B AD (TBAD) is changing, with the greater use of thoracic aortic stent grafts (TEVAR) in treatment and fewer open surgical procedures performed. The study’s aim is to review the worldwide, English language published, literature on acute TBAD incidence and treatment, to report on its strengths and limitations, and better understand changes in incidence over time and between countries. Thirty-one studies were identified that focus on the epidemiology and treatment of TBAD. Eight of these studies report the incidence of acute TBAD as between of 0.5–6.3 per 100,000 person years. Hospital admissions for aortic dissection are reported to be increasing in six studies and stable in one study. The proportion of patients with TBAD operated on varies between studies (range 13% to 76%). Studies identify patient age (median 51–77 years), gender (range 48%–81% male) and prevalence of cardio-vascular risk factors, specifically hypertension, in the populations studied as independent factors influencing aortic dissection incidence. Treatment of acute TBAD remains largely conservative with analgesia, hypertension control and serial cross-sectional imaging (range 24%–87% TBAD medically treated). The use of TEVAR to treat acute AD is increasing worldwide (range 13%–76% TBAD treated with TEVAR). The incidence of TBAD is under-reported due to out of hospital deaths, variable clinical presentation (miss-diagnosis) and coding errors. Importantly for research, the single International Classification of Diseases (ICD) code for aortic dissection, I17.0, does not distinguish between acute, chronic, type A or type B dissection types. Similarly, the OPCS Classification of Interventions and Procedures version 4 (OPCS-4) codes for TEVAR, L27.4 and L28.4, do not distinguish between acute and chronic AD presentation, unlike the codes for open thoracic aortic replacement. Standardised reporting of aortic dissection type, and the urgency of both the initial presentation (acute or chronic) and treatment (emergency, urgent or planned) in future studies would allow more meaningful comparisons between populations. Full article