RESUMEN
Research on the pathophysiological mechanism of carotid artery dissection and its clinical translation is limited due to the lack of effective animal models to simulate the occurrence of this condition. Assuming that intimal injury is an important factor in the formation of carotid dissection, we established a novel method for inducing carotid dissection models by scraping the carotid intima using a fine needle. Scraping the carotid intima with fine needles can induce the rapid formation of carotid dissection. Magnetic resonance imaging and hematoxylin-eosin staining suggest the presence of false lumens and mural hematomas in the vessels. Our model-induction technique, inspired by iatrogenic catheter-induced artery dissections (carotid, coronary, aortic), significantly mimics the pathological process of clinical carotid dissection. The results suggest that mechanical injury may be a significant cause of carotid dissection and that intimal injury is a major factor in the formation of arterial dissections. This approach will provide assistance in the understanding of medically induced arterial dissection.
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Modelos Animales de Enfermedad , Túnica Íntima , Animales , Túnica Íntima/patología , Túnica Íntima/lesiones , Masculino , Arterias Carótidas/patología , Arterias Carótidas/diagnóstico por imagen , Disección de la Arteria Carótida Interna/diagnóstico por imagen , Disección de la Arteria Carótida Interna/etiología , Disección de la Arteria Carótida Interna/patología , Traumatismos de las Arterias Carótidas/patología , Traumatismos de las Arterias Carótidas/diagnóstico por imagen , Traumatismos de las Arterias Carótidas/etiología , Disección Aórtica/diagnóstico por imagen , Disección Aórtica/patología , Disección Aórtica/etiologíaAsunto(s)
Disección Aórtica , Insuficiencia de la Válvula Aórtica , Ecocardiografía Transesofágica , Seno Aórtico , Tomografía Computarizada por Rayos X , Humanos , Disección Aórtica/diagnóstico por imagen , Disección Aórtica/complicaciones , Seno Aórtico/diagnóstico por imagen , Insuficiencia de la Válvula Aórtica/diagnóstico por imagen , Insuficiencia de la Válvula Aórtica/etiología , Insuficiencia de la Válvula Aórtica/cirugía , Masculino , Aneurisma de la Aorta/diagnóstico por imagen , Aneurisma de la Aorta/complicaciones , Persona de Mediana Edad , Enfermedad AgudaRESUMEN
BACKGROUND: Postoperative computed tomography imaging surveillance is an essential component of care after acute type A aortic dissection (ATAAD) repair. Prognostic imaging factors after ATAAD repair have not been systematically reviewed. METHODS AND RESULTS: We performed a systematic review to summarize postoperative computed tomography measurements including aortic diameter, cross-sectional area, volume, growth rate, and false lumen thrombosis in addition mid- to long-term clinical outcomes after ATAAD repair. Searches were conducted in Medline, Embase, and CENTRAL in October 2022. Studies were included if they reported clinical outcomes such as mortality or aortic reintervention after 1 year and included aforementioned computed tomography findings. Studies of chronic aortic dissection and studies of exclusive patient populations such as those with connective tissue diseases were excluded. Risk of bias was assessed with the Newcastle-Ottawa Scale. Searches retrieved 6999 articles. Sixty-eight studies met inclusion criteria (7885 patients). Extended repairs were associated with improved false lumen thrombosis, decreased aortic growth rate, and decreased rates of reintervention but not improved survival. Growth rates of the aorta post-ATAAD repair were highest in the descending thoracic aorta. The most frequent prognostic imaging factors reported were a patent/partially thrombosed false lumen and postoperative aortic diameter >40 to 45 mm. CONCLUSIONS: Established measurements of positive aortic remodeling, including complete false lumen thrombosis and stabilization of postoperative aortic diameter and growth are the most studied prognostic indicators for improved clinical outcomes after ATAAD repair. Growth rate of the aorta remains significant after ATAAD repair. Future studies should prospectively evaluate and compare prognostic factors for improved surveillance and management.
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Disección Aórtica , Humanos , Disección Aórtica/cirugía , Disección Aórtica/diagnóstico por imagen , Enfermedad Aguda , Resultado del Tratamiento , Aneurisma de la Aorta Torácica/cirugía , Aneurisma de la Aorta Torácica/diagnóstico por imagen , Tomografía Computarizada por Rayos X , Angiografía por Tomografía Computarizada , Pronóstico , Aorta Torácica/diagnóstico por imagen , Aorta Torácica/cirugía , Implantación de Prótesis Vascular/efectos adversos , Aneurisma de la Aorta/cirugía , Aneurisma de la Aorta/diagnóstico por imagenRESUMEN
This was the case of a male patient in his 60s, who suddenly collapsed. When the ambulance team arrived, the initial waveform was pulseless electrical activity; accordingly, a supraglottic airway device was inserted, and the patient was immediately transported to a referring hospital. On arrival, the patient resumed spontaneous circulation, the patient was diagnosed with Stanford type B acute aortic dissection and was referred to the author's hospital, where diffuse swelling of the anterior cervical region was revealed. CT performed by the previous hospital revealed compression of the trachea. The cause of cardiac arrest was considered to be severe airway stenosis secondary to a retropharyngeal haematoma associated with Stanford type B acute aortic dissection. Stanford type B acute aortic dissection can be complicated by retropharyngeal haematomas, which can lead to airway obstruction and even cardiac arrest. This condition also requires careful airway examination.
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Obstrucción de las Vías Aéreas , Disección Aórtica , Paro Cardíaco , Hematoma , Humanos , Masculino , Paro Cardíaco/etiología , Hematoma/diagnóstico por imagen , Hematoma/complicaciones , Hematoma/etiología , Obstrucción de las Vías Aéreas/etiología , Obstrucción de las Vías Aéreas/diagnóstico por imagen , Disección Aórtica/complicaciones , Disección Aórtica/diagnóstico por imagen , Disección Aórtica/diagnóstico , Persona de Mediana Edad , Enfermedades Faríngeas/complicaciones , Enfermedades Faríngeas/diagnóstico por imagen , Enfermedades Faríngeas/diagnóstico , Tomografía Computarizada por Rayos XRESUMEN
Iatrogenic coronary dissections are rare but potentially serious. Their management is complex, particularly if the dissection occurs without an angioplasty guide in the arterial lumen. In this context, angiography alone is insufficient, and endocoronary imaging is essential (using optical coherence or IVUS) to guide angioplasty when necessary (guide in the true lumen, coverage of the tear). We report here the case of an iatrogenic dissection of the right coronary artery treated with OFDI guiding.
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Enfermedad Iatrogénica , Humanos , Tomografía de Coherencia Óptica , Vasos Coronarios/lesiones , Vasos Coronarios/diagnóstico por imagen , Angiografía Coronaria/efectos adversos , Masculino , Ultrasonografía Intervencional , Persona de Mediana Edad , Disección Aórtica/diagnóstico por imagen , Disección Aórtica/etiología , Disección Aórtica/cirugía , Angioplastia Coronaria con Balón/efectos adversos , Anciano , FemeninoRESUMEN
OBJECTIVES: Intimal tears caused by aortic dissection can weaken the arterial wall and lead to aortic aneurysms. However, the effect of different tear states on the blood flow behaviour remains complex. This study uses a novel approach that combines numerical haemodynamic simulation with in vitro experiments to elucidate the effect of arterial dissection rupture on the complex blood flow state within the abdominal aneurysm and the endogenous causes of end-organ malperfusion. MATERIALS AND METHODS: Based on the CT imaging data and clinical physiological parameters, the overall arterial models including aortic dissection and aneurysm with single tear and double tear were established, and the turbulence behaviours and haemodynamic characteristics of arterial dissection and aneurysm under different blood pressures were simulated by using non-Newtonian flow fluids with the pulsatile blood flow rate of the clinical patients as a cycle, and the results of the numerical simulation were verified by in vitro simulation experiments. RESULTS: Hemodynamic simulations revealed that the aneurysm and single-tear false lumen generated a maximum pressure of 320.591 mmHg, 267 % over the 120 mmHg criterion. The pressure differential generates reflux, leading to a WSS of 2247.9 Pa at the TL inlet and blood flow velocities of up to 6.41 m/s inducing extend of the inlet. DTD Medium FL instantaneous WP above 120 mmHg Standard 151 % Additionally, there was 82.5 % higher flow in the right iliac aorta than in the left iliac aorta, which triggered malperfusion. Thrombus was accumulated distal to the tear and turbulence. These results are consistent with the findings of the in vitro experiments. CONCLUSIONS: This study reveals the haemodynamic mechanisms by which aortic dissection induces aortic aneurysms to produce different risk states. This will contribute to in vitro simulation studies as a new fulcrum in the process of moving from numerical simulation to clinical trials.
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Aorta Abdominal , Hemodinámica , Humanos , Aorta Abdominal/fisiopatología , Aorta Abdominal/diagnóstico por imagen , Rotura de la Aorta/fisiopatología , Rotura de la Aorta/diagnóstico por imagen , Disección Aórtica/fisiopatología , Disección Aórtica/diagnóstico por imagen , Aneurisma de la Aorta Abdominal/fisiopatología , Modelos CardiovascularesRESUMEN
BACKGROUND AND OBJECTIVE: The isolated superior mesenteric artery dissection (ISMAD) is a rare but potentially fatal vascular disorder. Classifications for ISMAD were previously proposed based on morphometric features. However, the classification systems were not standardized and verified yet. This study conducted computational flow analysis to validate the latest classification system of ISMAD and aid clinical decision-making based on hemodynamic parameters. METHODS: 62 patients with ISMAD were included and classified into different types according to false lumen structures (five types, Type I-V) and true lumen patency (two types, Type P and Type S) according to Qiu classification system. Computational fluid dynamics and three-dimensional structural analyses were conducted on the basis of computed tomography angiography datasets. Quantitative and qualitative functional analyses were performed via parameters of interest including volume flow of each minute, pressure drop, pressure gradient, the derivative parameters of wall shear stress such as time-averaged wall shear stress (TAWSS), oscillatory shear index (OSI), and the relative residence time (RRT). Statistical analyses were conducted among different ISMAD types. RESULTS: TAWSS, OSI and RRT showed significant difference among different types when classified using false lumen structures. In detail, Type IV showed significantly higher TAWSS than other types (p = 0.007). OSI was obviously higher in Type II (p = 0.015). Type IV also presented the lowest RRT (p = 0.005). The pressure drop, pressure gradient, OSI and RRT showed higher value in Type S than that in Type P, demonstrating a statistical significance with p values of 0.017, 0.041, 0.001 and 0.012, respectively. While Type P had larger volume flow than Type S (p = 0.041). CONCLUSIONS: The notable differences in hemodynamic features among different types demonstrated the feasibility of Qiu classification system. The evaluation based on hemodynamic simulation might also provide insights into risk identification and guide therapeutic decisions for ISMAD.
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Disección Aórtica , Hemodinámica , Arteria Mesentérica Superior , Humanos , Persona de Mediana Edad , Masculino , Femenino , Arteria Mesentérica Superior/diagnóstico por imagen , Arteria Mesentérica Superior/fisiopatología , Disección Aórtica/diagnóstico por imagen , Disección Aórtica/clasificación , Disección Aórtica/fisiopatología , Angiografía por Tomografía Computarizada/métodos , Adulto , Anciano , Hidrodinámica , Imagenología Tridimensional , Estrés MecánicoAsunto(s)
Disección Aórtica , Arteria Basilar , Síndrome de Enclaustramiento , Humanos , Arteria Basilar/diagnóstico por imagen , Disección Aórtica/diagnóstico por imagen , Disección Aórtica/complicaciones , Síndrome de Enclaustramiento/diagnóstico por imagen , Síndrome de Enclaustramiento/complicaciones , Masculino , Persona de Mediana Edad , Angiografía Cerebral , Angiografía por Tomografía Computarizada/métodos , FemeninoAsunto(s)
Aneurisma , Disección Aórtica , Complejo de Eisenmenger , Arteria Pulmonar , Humanos , Complejo de Eisenmenger/diagnóstico por imagen , Complejo de Eisenmenger/complicaciones , Arteria Pulmonar/diagnóstico por imagen , Disección Aórtica/diagnóstico por imagen , Disección Aórtica/complicaciones , Disección Aórtica/cirugía , Aneurisma/diagnóstico por imagen , Aneurisma/complicaciones , Masculino , Femenino , Angiografía por Tomografía Computarizada/métodos , Tomografía Computarizada por Rayos X/métodos , AdultoAsunto(s)
Aneurisma de la Aorta Torácica , Disección Aórtica , Implantación de Prótesis Vascular , Procedimientos Endovasculares , Corazón Auxiliar , Humanos , Disección Aórtica/cirugía , Disección Aórtica/fisiopatología , Disección Aórtica/diagnóstico por imagen , Disección Aórtica/diagnóstico , Aneurisma de la Aorta Torácica/cirugía , Aneurisma de la Aorta Torácica/diagnóstico , Procedimientos Endovasculares/métodos , Implantación de Prótesis Vascular/métodos , Masculino , Resultado del Tratamiento , Angiografía por Tomografía Computarizada , Persona de Mediana Edad , Aortografía , Diseño de Prótesis , Prótesis Vascular , Disección Aórtica AbdominalRESUMEN
OBJECTIVE: Aortic Dissection (AD) is one of the most fatal acute diseases in cardiovascular diseases, with rapid onset and progression and a high fatality rate. This study aims to investigate the clinical values of non-enhancement peripheral pulse-gating rapid magnetic resonance imaging in deterministic diagnosis of AD. METHODS: Aorta magnetic resonance imaging was performed in 21 healthy volunteers at a 1.5t MR scanner sequences including cardiac-gated and peripheral pulse-gated True-FISP and HASTE were carried out separately. Acquisition Time (TA), Signal to Noise Ratio (SNR), Contrast Noise Ratio (CNR), and entirety of vessel wall blood flow artifacts were measured and compared. A total of 56 AD cases were displayed by non-enhancement peripheral pulse-gating fast MR imaging, and the results were compared with pathological findings or CTA of the aorta. The dissection rupture, tear film, true and false lumen, thrombosis, hydropericardium, and the main branches of AD were evaluated respectively. RESULTS: There were no significant differences in SNR, CNR, entirety of the vessel wall, and blood flow artifact between cardiac-gated and peripheral pulse-gated fast MR imaging. Non-enhancement pulse-gated fast scanning takes less TA time. By the pulse-gated non-enhancement fast MR imaging, the dissection rupture, tear film, true and false cavity, thrombosis, hydropericardium, and the main branches of aortic dissection were shown clearly. Multi-planar and multi-angle scans helped to show the extent of entrapment rupture, whereas partial complex tears or bi-directional tears were slightly less well visualized. CONCLUSION: Non-enhancement peripheral pulse-gated rapid magnetic resonance imaging can be used for deterministic diagnosis of AD.
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Disección Aórtica , Imagen por Resonancia Magnética , Humanos , Disección Aórtica/diagnóstico por imagen , Masculino , Femenino , Adulto , Persona de Mediana Edad , Imagen por Resonancia Magnética/métodos , Relación Señal-Ruido , Aneurisma de la Aorta/diagnóstico por imagen , Anciano , Reproducibilidad de los Resultados , Adulto Joven , Técnicas de Imagen Sincronizada Cardíacas/métodos , Valores de ReferenciaRESUMEN
BACKGROUND: Aortic arch disease is a major cause of acute dissections. Surgical replacement is the current curative treatment for aortic arch disease. While traditional aortic cannulation ensures lower body perfusion, axillary cannulation offers optimum cerebral perfusion. AIM: To evaluate the outcomes of aortic and axillary cannulation methods in hemiarch replacements, focusing on postoperative perfusion and survival. MATERIALS AND METHODS: A retrospective analysis was conducted on 91 patients who underwent hemiarch replacement surgery between February 2007 and October 2016. Patients were divided into two groups based on the cannulation method: aortic cannulation (54 patients) and axillary cannulation (37 patients). Data regarding preoperative, intraoperative, and postoperative parameters were analyzed, including demographics, surgical outcomes, and complications. RESULTS: Demographic analysis showed comparable characteristics between the two groups, with notable differences in aortic disease severity and classification. Patients in the axillary group had a larger ascending aorta diameter (57.7 ± 10.8 mm vs. 51.8 ± 5.7 mm, p = 0.002) and a higher prevalence of acute dissections (27.0% (n = 10) vs. 3.7% (n = 2), p = 0.001). Cerebral protection methods varied significantly between the two groups (p < 0.001). Antegrade cerebral perfusion was used in 37.8% (n = 14) of the axillary group compared to 3.7% (n = 2) of the central group. The central cannulation group had a higher proportion of patients with temperatures under 20 °C (98.1% (n = 53) vs. 21.6% (n = 8), p < 0.001), whereas the axillary group maintained higher temperatures (24 -28 °C) in 68.6% (n = 23) of cases. AV repair/replacement was more frequent in the aortic cannulation group (48.2% (n = 26) vs. 18.9% (n = 7), p = 0.013). No significant disparities were observed in operative mortality or intraoperative complications. Statistical analysis showed no significant differences between the two groups in the in-hospital outcomes, but renal complications were more prevalent in the axillary cannulation group with 21.6% (n = 8) experiencing acute kidney injury compared to 9.3% (n = 5) in the central group (p = 0.098). The overall survival rate was slightly higher in the aortic cannulation group at various follow-up periods, yet no statistically significant difference was found between the two groups. CONCLUSION: We found no significant differences in safety and efficacy between axillary cannulation and aortic cannulation in hemiarch replacement procedures.
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Disección Aórtica , Arteria Axilar , Implantación de Prótesis Vascular , Cateterismo Periférico , Complicaciones Posoperatorias , Humanos , Estudios Retrospectivos , Femenino , Masculino , Persona de Mediana Edad , Cateterismo Periférico/efectos adversos , Cateterismo Periférico/mortalidad , Resultado del Tratamiento , Anciano , Factores de Riesgo , Disección Aórtica/cirugía , Disección Aórtica/diagnóstico por imagen , Disección Aórtica/mortalidad , Implantación de Prótesis Vascular/efectos adversos , Implantación de Prótesis Vascular/mortalidad , Complicaciones Posoperatorias/etiología , Factores de Tiempo , Circulación Cerebrovascular , Aneurisma de la Aorta Torácica/cirugía , Aneurisma de la Aorta Torácica/diagnóstico por imagen , Aneurisma de la Aorta Torácica/mortalidad , Aorta Torácica/cirugía , Aorta Torácica/diagnóstico por imagen , Aorta Torácica/fisiopatologíaRESUMEN
BACKGROUND: This study aims to identify a morphological indicator of aortic dissection (AD) based on the geometrical characteristics of the thoracic aorta. METHODS: We evaluated computed tomographic angiograms of 63 samples with AD (22 with type A AD, 41 with type B AD) and 71 healthy samples. Via centerline extraction and spatial transformation, the spatial entanglement of the aorta was minimized, and the expanded 2D aortic morphology was obtained. The 2D morphology of the thoracic aorta was fit to a circle. The applicability of the fitting circle method for identifying aortic dissection was verified by multivariable logistic regression analysis. RESULTS: Via the 3D coordinate transformation algorithm, the optimal aortic view was obtained. On this view, the geometrical characteristics of the thoracic aortas of the healthy controls were similar to a portion of a circle (sum of residuals: 3502.45 ± 2566.71, variance: 86.23 ± 56.60), while that of AD samples had poorer similarity to the circle (sum of residuals: 5404.78 ± 3891.69, variance: 129.90 ± 90.09). This difference was significant (p < 0.001). A logistic regression model showed that increased deformation of the thoracic aorta was a significant indicator of aortic dissection (odds ratio: 1.35, p = 0.034). CONCLUSIONS: The morphology of the healthy thoracic aorta could be fit to a circle, while that of the dissected aorta had poorer similarity to the circle. The statistics of the circle are an effective indicator of aortic deformation in AD. TRIAL REGISTRATION: This study is registered in the Chinese Clinical Trial Registry (ChiCTR2000029219).
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Aorta Torácica , Aneurisma de la Aorta Torácica , Disección Aórtica , Aortografía , Angiografía por Tomografía Computarizada , Valor Predictivo de las Pruebas , Interpretación de Imagen Radiográfica Asistida por Computador , Humanos , Disección Aórtica/diagnóstico por imagen , Aorta Torácica/diagnóstico por imagen , Aorta Torácica/patología , Aneurisma de la Aorta Torácica/diagnóstico por imagen , Masculino , Femenino , Persona de Mediana Edad , Anciano , Estudios de Casos y Controles , Adulto , Estudios Retrospectivos , Tomografía Computarizada MultidetectorRESUMEN
Persistent sciatic artery( PSA) is a rare congenital anomaly and often results in aneurismal or occlusive changes. A 82-year-old woman was reffered with diagnosis of Stanford type A acute aortic dissection complicated cardiac tamponade. Emergent aortic arch replacement was performed. Cardiopulmonary bypass was established by central cannulation into true lumen of aortic arch because of asceding aortic rupture during the operation, axillary arteries dissection and hypoplastic femoral arteries. Post-operative course was uneventful. She was transferred to the local hospital 32 days after the operation for the purpose of rehabilitation.
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Disección Aórtica , Humanos , Femenino , Anciano de 80 o más Años , Disección Aórtica/cirugía , Disección Aórtica/complicaciones , Disección Aórtica/diagnóstico por imagen , Enfermedad Aguda , Rotura de la Aorta/cirugía , Rotura de la Aorta/diagnóstico por imagen , Rotura de la Aorta/complicaciones , Aneurisma de la Aorta Torácica/cirugía , Aneurisma de la Aorta Torácica/diagnóstico por imagen , Aneurisma de la Aorta Torácica/complicaciones , Resultado del TratamientoAsunto(s)
Disección Aórtica , Humanos , Disección Aórtica/mortalidad , Disección Aórtica/cirugía , Disección Aórtica/diagnóstico por imagen , Factores de Riesgo , Masculino , Femenino , Tasa de Supervivencia , Enfermedad Aguda , Aneurisma de la Aorta/cirugía , Aneurisma de la Aorta/mortalidad , Aneurisma de la Aorta/diagnóstico por imagen , Persona de Mediana Edad , Anciano , Resultado del Tratamiento , Prevalencia , Comorbilidad , Medición de RiesgoRESUMEN
Aortic dissection is a catastrophic, life-threatening event. Its management depends on the anatomic location of the intimal tear (type A v B) and the clinical presentation in type B aortic dissection. In this article, the current evidence supporting clinical practice, gaps in knowledge, and the need for more rigorous research and higher-quality studies are reviewed.
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Aneurisma de la Aorta , Disección Aórtica , Implantación de Prótesis Vascular , Procedimientos Endovasculares , Humanos , Disección Aórtica/diagnóstico por imagen , Disección Aórtica/terapia , Disección Aórtica/cirugía , Aneurisma de la Aorta/diagnóstico por imagen , Aneurisma de la Aorta/terapia , Aneurisma de la Aorta/cirugía , Resultado del Tratamiento , Factores de Riesgo , Procedimientos Endovasculares/efectos adversos , Procedimientos Endovasculares/normas , Implantación de Prótesis Vascular/efectos adversos , Implantación de Prótesis Vascular/normas , Toma de Decisiones Clínicas , Selección de PacienteRESUMEN
BACKGROUND: Pediatric spontaneous intracranial dissecting aneurysms are rare, but systematic studies comparing hemorrhagic and ischemic presentations are lacking. This study addresses gaps in understanding their epidemiology, clinical presentation, management, and outcome. METHODS: A retrospective analysis of 23 pediatric patients with nontraumatic intracranial dissecting aneurysms treated between July 2018 and December 2023 was conducted. Patients were divided into 2 groups based on presentation: hemorrhagic (n = 16) and ischemic (n = 7). Clinical data were analyzed, including demographics, radiologic findings, treatment modalities, and outcomes. RESULTS: Clinical presentations varied, with limb weakness being more prevalent in hemorrhagic cases (P = 0.014), while headache and seizures were more common in ischemic cases. Angiographic analysis revealed distinct patterns, with hemorrhagic cases showing more distal involvement on vessel segments with stenosis and dilatation (pearl string sign). At the same time, the ischemic group exhibited the double-lumen sign. Various treatments, including microsurgery and endovascular techniques, were utilized, with perioperative complications observed, including one mortality in a hemorrhagic case. Multiple regression analysis identified significant risk factors for perioperative complications, namely, the configuration of the dissecting aneurysm (P = 0.016) and the type of presentation (P = 0.0006). Long-term Glasgow Outcome Scores were comparable, but patients with hemorrhagic manifestations experienced prolonged hospital and ICU stays (P = 0.001). CONCLUSIONS: Pediatric intracranial dissecting aneurysms, particularly hemorrhagic cases, are associated with severe neurologic deficits and higher perioperative complications. Despite similar long-term outcomes, hemorrhagic cases require prolonged hospitalization, increasing treatment costs. Optimizing management strategies for pediatric intracranial dissecting aneurysms, especially those with hemorrhagic features, is essential to improve outcomes and reduce healthcare expenditures.
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Disección Aórtica , Isquemia Encefálica , Procedimientos Endovasculares , Aneurisma Intracraneal , Humanos , Masculino , Femenino , Procedimientos Endovasculares/métodos , Niño , Aneurisma Intracraneal/cirugía , Aneurisma Intracraneal/diagnóstico por imagen , Aneurisma Intracraneal/epidemiología , Aneurisma Intracraneal/complicaciones , Aneurisma Intracraneal/terapia , Estudios Retrospectivos , Adolescente , Disección Aórtica/cirugía , Disección Aórtica/diagnóstico por imagen , Disección Aórtica/epidemiología , Isquemia Encefálica/etiología , Isquemia Encefálica/epidemiología , Isquemia Encefálica/cirugía , Países en Desarrollo , Preescolar , Hemorragias Intracraneales/etiología , Hemorragias Intracraneales/epidemiología , Hemorragias Intracraneales/cirugía , Resultado del TratamientoRESUMEN
ABSTRACT: Intraoperative aortic dissection is a life-threatening emergency. The prognosis of patients with aortic dissection has markedly improved in recent years due to prompt diagnosis and the institution of effective medical and surgical therapy. Transesophageal echocardiography (TEE) is helpful in the evaluation of this life-threatening disorder.
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Aorta , Disección Aórtica , Ecocardiografía Transesofágica , Complicaciones Intraoperatorias , Humanos , Disección Aórtica/cirugía , Disección Aórtica/diagnóstico por imagen , Ecocardiografía Transesofágica/métodos , Aorta/cirugía , Aorta/diagnóstico por imagen , Complicaciones Intraoperatorias/diagnóstico por imagen , Aneurisma de la Aorta/cirugía , Aneurisma de la Aorta/diagnóstico por imagen , Masculino , Femenino , Persona de Mediana EdadRESUMEN
In this work we present a novel methodology for the numerical simulation of patient-specific aortic dissections. Our proposal, which targets the seamless virtual prototyping of customized scenarios, combines an innovative two-step segmentation procedure with a CutFEM technique capable of dealing with thin-walled bodies such as the intimal flap. First, we generate the fluid mesh from the outer aortic wall disregarding the intimal flap, similarly to what would be done in a healthy aorta. Second, we create a surface mesh from the approximate midline of the intimal flap. This approach allows us to decouple the segmentation of the fluid volume from that of the intimal flap, thereby bypassing the need to create a volumetric mesh around a thin-walled body, an operation widely known to be complex and error-prone. Once the two meshes are obtained, the original configuration of the dissection into true and false lumen is recovered by embedding the surface mesh into the volumetric one and calculating a level set function that implicitly represents the intimal flap in terms of the volumetric mesh entities. We then leverage the capabilities of unfitted mesh methods, specifically relying on a CutFEM technique tailored for thin-walled bodies, to impose the wall boundary conditions over the embedded intimal flap. We tested the method by simulating the flow in four patient-specific aortic dissections, all involving intricate geometrical patterns. In all cases, the preprocess is greatly simplified with no impact on the computational times. Additionally, the obtained results are consistent with clinical evidence and previous research.
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Disección Aórtica , Simulación por Computador , Modelos Cardiovasculares , Humanos , Disección Aórtica/diagnóstico por imagen , Disección Aórtica/fisiopatología , Aneurisma de la Aorta/diagnóstico por imagen , Aneurisma de la Aorta/fisiopatología , Aorta/fisiopatología , Aorta/diagnóstico por imagenRESUMEN
Bifurcations are a common site for saccular aneurysms, but rarely can be a site for dissecting aneurysms. Identification of these aneurysms is extremely important because the management plan depends on it. We describe a rare case of a ruptured dissecting aneurysm at the right ICA bifurcation in a pre-teen child which posed a diagnostic dilemma but ultimately was successfully managed with flow diversion.