Abstract:

Introduction: intramural hematoma of the aortic wall is a component of acute aortic syndrome, and is also considered a precursor of aortic dissection. Due to peculiarities of the natural course, there are significant disagreements in choosing the optimal strategy for the treatment of intramural hematoma.

Aim: was to evaluate the possibility of a differential tactical approach to the treatment of acute intramural aortic hematoma in various situations.

Material and methods: two clinical cases demonstrate different approaches to the treatment of intramural aortic hematoma.

Results: in given clinical examples, a conservative tactics of managing patients with intramural hematoma of the aorta "watch and wait" was applied. However, in the first case, an emergency surgical intervention was required, due to the complicated course of the disease, according to dynamic studies. The second case demonstrated the acceptability of a conservative approach with long-term monitoring of the condition of the aortic wall.

Conclusions: the balance between risks of surgery and the safety of conservative therapy is the cornerstone in deciding on the optimal tactics for treating this pathology.

Abstract

Aim: was to estimate condition of aorta branches in case of aortic dissection, using multislice computed tomography (MSCT): we estimated frequency and type of changes of main branches of the aorta involved in the dissection.

Material and methods: a retrospective analysis of 104 patients with aortic dissection (AD) was performed. All patients were admitted to Scientific-Research Institute of Emergency Medicine named after N.V Sklifosovsky All studies were carried out on a multispiral (80x0.5) tomograph in early stages of the disease.

Results: MSCT method allowed to obtain data of the high frequency of transition of aortic dissection to main branches (63.5%), mainly to iliac arteries (81% and 77% of aortic dissection type A and B respectively), both in isolation and in combination with other branches. However, the frequency of occurrence of hemodynamically significant stenosis, both static and dynamic, was significantly higher in groups of visceral branches and brachiocephalic arteries (82% and 71%, respectively).

Conclusion: the CT method allows to evaluate in detail the lumen of the aorta and branches of aorta, and to determine type and degree of stenosis of aortic branches involved in the dissection. Revealed patterns of combining of involvement in different groups of aortic branches in the pathological process, allow to procced more optimized diagnostic search for complications of dissection, including MSCT.

References

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Abstract:

The report is about giant false aneurysm of an extracranial part of the left internal carotid artery (ICA) in a patient aged one year and nine months. The reason of the complexity of diagnostics in this case was that the dissection of the ICA with formation of false aneurysm imitated the peritonsillar abscess' clinic. We have not found any descriptions of a similar cases of patients at such an early age in modern literature.

References

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8.      Mazur E, Czerwinska E, Korona-Gtowniak I, Grochowalska A, Koziot-Montewka M. Epidemiology, clinical history and microbiology of peritonsillar abscess. Eur J Clin Microbiol Infect Dis. 2015 Mar; 34(3):549-54. doi.org/10.1007/s10096-014-2260-2.  

Abstract:

Aim: was to analyze long-term resuts of true lumen reconstruction in complicated aortic dissections type В with help of balloon-expandable stents under intravascular ultrasonic (IVUS) guidance as a preoperative evaluation of anatomy and morphology of lesion.

Materials and methods: 47 patients witn type В aortiс dissections underwent endovascular treatment in our departmert n 20 cases - IVUS was used for irtraoperative anatomy and morphology verification. Complications developed n 16 patients, and true lumen was reconstructed by stent-graft implantation (to cover proximal fenestration) followed by balloon-expandable stents implantation at the level of visceral arteries under IVUS control at every stage. 87,5% of patents were man, mean ago 51 8—16,2 years.

Results: Technical success was 100% True lumen total reconstruction was reached in every case under precise IVUS control. Visceral arteries malperfusion was not observed at hospital period or follow-up. З0-day mortality rate was 6,25% (1 case due to aortic rupture in uncovered part of aorta - 7 days after procedure). All 15 discharged patients survived for 1st year. Mean follow-up period is 3,3±1,6 years. One patient died due to aortobronchial fistula, 1 due to repeated stroke and 1 due to cancer. At CT-scan 2 years after implantation (10 cases) fractures of balloon-expandable stents were observed, without аnу influence on intraluminal size or stenotic lesion. True lumen size stayed stable for 1 year.

Conclusion: true lumen reconstruction under IVUS control seems to be feasible and effective in complicated Type B dissections, even with the use of balloon-expandable stents. The usage of additional intraoperative visualization - intraaortic IVUS is the key point in the development of advanced endovascular methods.

References

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2.      Fattori R., Cao P., De Rango P, et al. Interdisciplinary expert consensus document on management of type B aortic dissection. J Am Coll Cardiol. 2013; 61: 1661-78.

3.      Eggebrecht H., Nienaber C.A., Neuhauser M., et al. Endovascular stent graft placement in aortic dissection: a metaanalysis. Eur Heart J. 2006; 27: 489e98.

4.      Mossop P.J., McLachlan C.S., Amukotuwa S.A., Nixon I.K. Staged endovascular treatment for complicated type B aortic dissection. Nat Clin Pract Cardiovasc Med. 2005;2:316-21.

5.      Canaud L., Faure E.M., Ozdemir B.A., Alric P., Thompson M. (2014) Systematic review of outcomes of combined proximal stent-grafting with distal bare stenting for management of aortic dissection. Ann Cardiothorac Surg. 3: 223-233.

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7.      Evangelista A., Flachskampf F.A., Erbel R., et al. Echocardiography in aortic diseases: EAE recommendations for clinical practice. Eur J Echocardiogr. 2010; 11: 645-658.

8.      Fattori R., Caldarera I., Rapezzi C., et al. Primary endoleakage in endovascular treatment of the thoracic aorta: importance of intraoperative transesophageal echocardiography. J Thorac Cardiovasc Surg. 2000; 120: 490-5.

9.      Rocchi G., Lofiego C., Bigini E., et al. Transesophageal echocardiography-guided algorithm for stent-graft implantation in aortic dissection. J Vasc Surg. 2004; 40: 880-5.

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23.    Mossop P.J., McLachlan C.S., Amukotuwa S.A., Nixon I.K. Staged endovascular treatment for complicated type B aortic dissection. Nat Clin Pract Cardiovasc Med. 2005; 2: 316e22.

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Abstract:

For today it is possible to allocate two basic strategies of images primary analysis during virtual colonoscopy (VC): it means interpretation on the basis of 2D and 3D reconstruction data

Purpose. Was to compare 2D and 3D analysis programs during VC: they were compared on interpretation time,on sensitivity of polyp's detection

Materials and methods. The research consisted of 80 patients. All detected new growth during VC were put into protocols of interpretation, with instructions of quantity, form and size

All the patients were underwent VC, including biopsy and further histological research Also, time spent for analysis of each research was fixed

Conclusions. Sensitivity of 3D virtual dissection during primary imaging analysis in almost the same in comparison with 2D, but interpretation time is higher in 2D.  

References 

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Abstract:

Aortic aneurysms and dissections are life threatening problems and pose significant management challenges. Open operative repair is associated with significant morbidity and mortality and this has prompted an increasing interest in endoluminal solutions. There are well known and potentially catastrophic complications associated with failure to achieve a seal proximally at the time of insertion and with dislocation of the prosthesis.

A technique to improve fixation of the prosthesis in patients with short aortic “necks” in open and endoluminal procedures would be to staple the prosthesis to the aortic wall. A stapler would only be of value, especially for endoluminal procedures, if it could achieve transmural fixation with only endoluminal access.

It became possible because of the stapler construction, containing staples made from memory-shaped metals, which can form the rings after discharge.

The technology was designed by Australian company Endogene Pty. Ltd. in Russian and Australian research laboratories.

The study was performed over 6 years in separate experiments on 7 adult mongrel male dogs (average weight 20 kg), 5 sheep (average weight 47 kg) and 12 pigs (average weight 68 kg). Access to abdominal aorta was obtained by central laparotomy, with the animals under general anaesthesia (sodium phentobarbital, 30 mg/kg).

The deployment of the new stapler technology for graft fixation inside of animal aorta was successfully performed. The time taken for the procedure i.e., from introduction of the stapler into the aorta to removal was less than one minute. Observation of the anastomosis revealed complete staple penetration of the aortic wall and ring formation of the individual staples. There was no evidence of unexpected damage to the aortic wall and there was no bleeding at the sites of penetration of the staples through the aortic wall. In addition, there was no evidence of migration of the attached graft, or signs of thrombus formation or focal haemorrhages within the aortic wall.

The Endogene Pty. Ltd. stapler technique has been successfully used in an animal model with secure graft fixation being easily obtained.

Further research is required before this technology can achieve clinical application. 

References 

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Abstract:

We had analyzed percutaneous coronary intervention (PCI) of non-standard complications - coronary artery dissection with extension on the eft main coronary artery (LMCA) and aorta. There was the coronary dissection of LMCA and aorta after left internal thoracic arteries and left anterior descending anastomosis (LIMA-LAD) balloon predilatation. Satisfactory angiographic result was achieved with blood flow TIMI III after stent implantation. In connection with the stable condition of the patient there was no endovascular or surgical treatment. The patient had stable hemodynamics in hospital period. The angiografic control was performed after 8 days. There was no coronary and aorta dissection and stent-thrombosis.

In conclusion in can be said that conservative tactics may be useful in a case of retrograde coronary and aorta dissection after LIMA-LAD stent mplantation.

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Abstract:

Authors present their first 3 cases of thoracoabdominal aneurysm hybrid repair. Endovascular procedure and open surgery were used either simultaneously, or as the steps of reconstruction.

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Abstract:

Background: balloon angioplasty for coarctation of the aorta (CoA) in teenagers and adults is sometimes limited by significant residual pressure gradient (>20 mm Hg) in cause of vesse «elastic recoil». To avoid this complication intervention cardiologists use self- and balloon-expandable endovascular stents. In this report we demonstrate our experience in such method of aortic coarctation repair.

Materials and methods: in our instituton since December 2008 to Desember 2013 85 teenagers and adult patients were treated by endovascular stent placement to coarctatec aortic segment. The age of patients was 10 to 60 years (mean 20,3+7,4), weight 20 to 90 kgs (mean 53,2+14,6). Mean systolic arterial pressure was 166+7mm Hg. (range 140 to 200), mean systolic pressure gradient (SPG) was 60,6+9,0 mm Hg (range 25 to 85). The mean cross section at baseline of coarctation was 19,6±6,1 mm2 (range 1 to 95). 61 patients had native coarctation and 3 recoarctation after previous surgical repair. In 21 cases coartation was in combination with other cardiac pathology - patent ductus arteriosus (PDA), restrictive VSD, aortric and mitral valve lesions, and coronary vessel pathology Seven patients had hemodynamically significant aortic atresia. We used 20 Palmaz P-4014, 18 Genesis XD PG-2910 (Cordis Jonson & Jonson) and 45 - CP, CP covered stents, one - Intratherapeutic Doublestrut (EV3), and one Advanta V12 (Atrium) covered stent.

Results: 90 stents were implanted in 85 patients. Procedure was successful in all but one cases, one patient with postsurgical recoarctation had residual systolic pressure gradient > 25 mm Hg after stent placement. The peak systolic gradient decreased from a mean value of 60 mm Hg.(range 25 to 85) to a mean 7 mm Hg (range 0 to 25). Systolic blood pressure normalized in 64 cases, twenty one patients require additional drug therapy Coarctation site cross section increased from a mean of 19,6 mm2 to 236,3 mm2. PDA was closed simultaneously with the stenting by coils, and for eleven patients with other cardiac malformations endovascular coarctation repair was as a first step in complex cardiac surgical treatment. In one case of 56 years old male we had acute aortic dissection which was stabilized without surgical intervention. Two patients with complete hemodynamically significant aortic atresia developed stent fracture, which was recognized on CT scan 6 months after procedure. In one case it was treated with covered stent placement. In another patient stent fragment was treated surgically We had three stent migration with their safe deployment in thoracic aorta and followed by successful repair of aortic narrowing with additional stent.

Conclusion: stent implantation for aortic coarctation is safe and effective procedure. The early and intermediate term result are encouraging, with relatively low incidence of complication in teenagers and adult patients. 

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Abstract:

Article describes experience of Novosibirsk scientific-research institute of blood circulation pathology named after E.N.Meshalkin in hybrid interventions in aortic dissection.

Aim: was to estimate efficacy of hybrid methods in surgical treatment of aortic dissection .

Materials and methods: since 2011 - 17 operations on proximal aortic dissections and 8 operations on distal aortic dissection with use of hybrid methodics were made.

Results: mortality in early post-operative period - 2 patients and was determined by progression of heart insufficiency In late post-operative period, basing on MSCT data, thrombosis of false lumen of aortic dissection on the mark of stent-graft or bare-metal stent (descending thoracic aorta) was revealec in 7 of 10 patients (70%) and in all patients with hybrid endoprothesis. During observation in post-operative period, none of patients were marked as needed of operation on thoracic-abdominal aorta.

Conclusion: used techniques allow to gain number of advantages in this severe group of patients as n early post-operative period, and also in late post-operative period. Endovascular treatment, performing simultaneously with open surgical interventions - are safe for patient and easy for surgeon. More extended reconstruction of aorta in single-stage operation can exclude aneurysmatic degeneration and prevent operations on distal aorta. 

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