RESUMEN
AIMS: Patients with aortic dissection have a high prevalence of left ventricular structural alterations, including left ventricular hypertrophy (LVH), but little is known about the impact of sex on this regard. This study compared clinical, cardiac, and prognostic characteristics between men and women with aortic dissection. METHODS: We retrospectively assessed clinical and echocardiographic characteristics, and 1-year mortality in 367 aortic dissection patients (30% women; 66% with Stanford-A) who underwent echocardiography 60âdays before or after the diagnosis of aortic dissection from three Brazilian centers. RESULTS: Men and women had similar clinical characteristics, except for higher age (59.4â±â13.4 vs. 55.9â±â11.6âyears; P â=â0.013) and use of antihypertensive classes (1.4â±â1.3 vs. 1.1â±â1.2; P â=â0.024) and diuretics (32 vs. 19%; P â=â0.004) in women compared with men. Women had a higher prevalence of LVH (78 vs. 65%; P â=â0.010) and lower prevalence of normal left ventricular geometry (20 vs. 10%; P â=â0.015) than men. Logistic regression analysis adjusted for confounding factors showed that women were less likely to have normal left ventricular geometry (odds ratio, 95% confidence intervalâ=â0.42, 0.20-0.87; P â=â0.019) and were more likely to have LVH (odds ratio, 95% confidence intervalâ=â1.91, 1.11-3.27; P â=â0.019). Conversely, multivariable Cox-regression analysis showed that women had a similar risk of death compared to men 1 year after aortic dissection diagnosis (hazard ratio, 95% confidence intervalâ=â1.16, 0.77-1.75; P â=â0.49). CONCLUSION: In aortic dissection patients, women were typically older, had higher use of antihypertensive medications, and exhibited a greater prevalence of LVH compared with men. However, 1-year mortality after aortic dissection diagnosis did not differ between men and women.
Asunto(s)
Disección Aórtica , Hipertrofia Ventricular Izquierda , Remodelación Ventricular , Humanos , Masculino , Femenino , Disección Aórtica/epidemiología , Disección Aórtica/fisiopatología , Disección Aórtica/mortalidad , Persona de Mediana Edad , Estudios Retrospectivos , Factores Sexuales , Anciano , Hipertrofia Ventricular Izquierda/fisiopatología , Hipertrofia Ventricular Izquierda/epidemiología , Hipertrofia Ventricular Izquierda/diagnóstico por imagen , Brasil/epidemiología , Prevalencia , Adulto , Factores de Riesgo , Ecocardiografía , Aneurisma de la Aorta/epidemiología , Aneurisma de la Aorta/mortalidad , Aneurisma de la Aorta/diagnóstico por imagen , Aneurisma de la Aorta/fisiopatología , Pronóstico , Factores de TiempoRESUMEN
Background This study compared left ventricular (LV) characteristics between patients with type-A and type-B aortic dissection (AD) and evaluated the ability of LV remodeling phenotypes (hypertrophy, concentricity, or geometric patterns) to predict mortality in both AD types. Methods and Results We evaluated 236 patients with type A and 120 patients with type B who had echocardiograms within 60 days before or after AD diagnosis (median [25th, 75th percentiles] time difference between echocardiogram and AD diagnosis=1 [0, 6] days) from 3 centers. Patients were stratified according to LV phenotypes, and early (90-day) and late (1-year) mortality after AD diagnosis were assessed. In adjusted logistic regression analysis, patients with type A had higher and lower odds of concentric and eccentric hypertrophy (odds ratio [OR], 2.56; 95% CI, 1.50-4.36; P<0.001; and OR, 0.55; 95% CI, 0.31-0.97; P=0.039, respectively) than those with type B. Results of multivariable Cox-regression analysis showed that LV remodeling phenotypes were not related to mortality in patients with type B. By contrast, LV concentricity was associated with greater early and late mortality (hazard ratio [HR], 2.22; 95% CI, 1.24-3.96; P=0.007 and HR, 2.06; 95% CI, 1.20-3.54; P=0.009, respectively) in type A. In further analysis considering normal LV geometry as reference, LV concentric remodeling and concentric hypertrophy were associated with early mortality (HR, 7.78; 95% CI, 2.35-25.78; P<0.001 and HR, 4.38; 95% CI, 1.47-13.11; P=0.008, respectively), whereas concentric remodeling was associated with late mortality (HR, 5.40; 95% CI, 1.91-15.26; P<0.001) among patients with type A. Assessment of LV geometric patterns and concentricity provided incremental prognostic value in predicting early and late mortality beyond clinical variables in patients with type A based on net reclassification improvement and integrated discrimination improvement. Conclusions LV geometric patterns derived from LV concentricity were associated with greater mortality among patients with type A and may be markers of adverse prognosis in this population.
Asunto(s)
Aneurisma de la Aorta Torácica/diagnóstico , Disección Aórtica/diagnóstico , Ventrículos Cardíacos/diagnóstico por imagen , Función Ventricular Izquierda/fisiología , Remodelación Ventricular/fisiología , Disección Aórtica/mortalidad , Disección Aórtica/fisiopatología , Aneurisma de la Aorta Torácica/mortalidad , Aneurisma de la Aorta Torácica/fisiopatología , Brasil/epidemiología , Progresión de la Enfermedad , Ecocardiografía , Femenino , Estudios de Seguimiento , Ventrículos Cardíacos/fisiopatología , Humanos , Masculino , Persona de Mediana Edad , Pronóstico , Estudios Retrospectivos , Tasa de Supervivencia/tendenciasRESUMEN
Hypoxic hepatitis is an uncommon cause of hepatic damage characterized by a centrolobular necrosis. Its pathophysiology remains unclear. Aortic dissection is a rare but frequently catastrophic event. It is caused by an aortic intimal tear with propagation of a false channel in the media. Depending on the site and extension, it can cause hypoperfusion of any organ leading to cellular ischemia and necrosis. We are presenting a case of hypoxic hepatitis in a patient with an extensive aortic dissection who present to the emergency department.
Asunto(s)
Disección Aórtica/complicaciones , Hepatitis/etiología , Isquemia/etiología , Hígado/irrigación sanguínea , Dolor Abdominal/etiología , Disección Aórtica/diagnóstico , Disección Aórtica/fisiopatología , Aneurisma de la Aorta/complicaciones , Aneurisma de la Aorta/diagnóstico por imagen , Disnea/etiología , Urgencias Médicas , Resultado Fatal , Hepatitis/diagnóstico por imagen , Humanos , Masculino , Persona de Mediana Edad , Tomografía Computarizada por Rayos XRESUMEN
Hypoxic hepatitis is an uncommon cause of hepatic damage characterized by a centrolobular necrosis. Its pathophysiology remains unclear. Aortic dissection is a rare but frequently catastrophic event. It is caused by an aortic intimal tear with propagation of a false channel in the media. Depending on the site and extension, it can cause hypoperfusion of any organ leading to cellular ischemia and necrosis. We are presenting a case of hypoxic hepatitis in a patient with an extensive aortic dissection who present to the emergency department.
La hepatitis hipóxica es una causa poco frecuente de daño hepático caracterizada por una necrosis centrolobular. Su fisiopatología sigue siendo poco clara. La disección aórtica es un evento raro pero con frecuencia catastrófico. Dependiendo del sitio y la extensión, puede causar hipoperfusión de cualquier órgano lo que conduce a una isquemia celular y necrosis. Nosotros presentamos un caso de hepatitis hipóxica en un paciente con disección aórtica extensa que se presenta al servicio de emergencia.
Asunto(s)
Humanos , Masculino , Persona de Mediana Edad , Hepatitis/etiología , Isquemia/etiología , Disección Aórtica/complicaciones , Hígado/irrigación sanguínea , Aneurisma de la Aorta/complicaciones , Aneurisma de la Aorta/diagnóstico por imagen , Tomografía Computarizada por Rayos X , Dolor Abdominal/etiología , Resultado Fatal , Disnea/etiología , Urgencias Médicas , Hepatitis/diagnóstico por imagen , Disección Aórtica/diagnóstico , Disección Aórtica/fisiopatologíaRESUMEN
Acute aortic syndrome includes a group of diseases that have clinical similarity in their natural history, the most important characteristic being their association with a high vital risk. The diagnosis and management of aortic dissection depends on the degree of aortic involvement according to the location of the lesion, as defined by the Stanford classification. In this syndrome, chest pain is considered the cardinal symptom; however, there are situations where clinical feedback is difficult. We present the case of a patient who debuted with a Stanford A aortic dissection, with an indication for surgical resolution in the acute phase, but who unexpectedly presented unspecific clinical manifestations. An opportune diagnosis was not obtained. After repeated consultations for changes in his symptoms, the definitive diagnosis was determined through imaging study, evolving favorably with ambulatory therapy.
El síndrome aórtico agudo incluye un grupo de enfermedades que poseen similitud clínica en su historia natural, siendo la característica más importante su asociación a un alto riesgo vital. Entre estas patologías, el diagnóstico y manejo de la disección aórtica depende del grado de compromiso aórtico según la ubicación de la lesión definida bajo la clasificación de Stanford. Dentro de las manifestaciones clave se considera al dolor torácico como el síntoma cardinal. Sin embargo, existen situaciones que por ambigüedad clínica retrasan el diagnóstico. Se presenta el caso de un paciente que debutó con una disección aórtica Stanford A, con indicación de resolución quirúrgica en fase aguda pero que dado lo inespecífico de su cuadro clínico, no se logró un diagnóstico oportuno. Posterior a reiteradas consultas por cambios en su sintomatología, se determinó el cuadro definitivo a través de estudio imagenológico, evolucionando de forma favorable con terapia ambulatoria.
Asunto(s)
Disección Aórtica/diagnóstico , Dolor en el Pecho/etiología , Disección Aórtica/fisiopatología , Diagnóstico Tardío , Humanos , Masculino , Persona de Mediana EdadRESUMEN
OBJECTIVE: To review aortic dissection (AD) in the Mexican population. METHOD: A retrospective study was conducted using 434 medical records of patients with aortic angio-tomography between November 2014 and October 2015. A sample was obtained of 32 patients with a first time diagnosis of AD. An analysis was performed of the dissections according to gender, age group, Stanford/De Bakey classification, and mortality rate 6 months after diagnosis. Statistical analysis was performed by obtaining the Chi squared index for the independent variables of gender, Marfan syndrome, systemic arterial hypertension, as well as calcified atheromatous disease in association with dissection subtypes, re-entry sites, and hypo-perfusion signs. RESULTS: The patients included 65.6% males with a mean age of 54.5 years, and 34.4% females with mean age of 42.5 years. The most common dissection subtype was B/3. Mortality rate at 6 months was 18.7%. There was a significant association, with a marginal P in patients with Marfan syndrome and Stanford subtypes of AD (P=.0506). There was a significant association in patients with abdominal aortic aneurysm, when compared with Stanford subtypes of AD (P=.047104). CONCLUSIONS: AD is an emergency in which diagnosis and timely management are essential to improve prognosis. In the sample presented here, a significant association was found in patients with a history of Marfan syndrome and abdominal aneurysms with dissections according to the Stanford classification. The rest of the independent variables did not show any significant association, probably related to the size of the sample.
Asunto(s)
Aneurisma de la Aorta Abdominal/diagnóstico por imagen , Disección Aórtica/diagnóstico por imagen , Angiografía por Tomografía Computarizada/métodos , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Disección Aórtica/mortalidad , Disección Aórtica/fisiopatología , Femenino , Humanos , Hipertensión/complicaciones , Masculino , Síndrome de Marfan/complicaciones , México , Persona de Mediana Edad , Pronóstico , Estudios Retrospectivos , Tamaño de la Muestra , Adulto JovenRESUMEN
A dissecção da aorta é uma condição grave cujo diagnóstico preciso precoce é fun-damental para a sobrevida dos pacientes. Dentro do contexto da dor torácica aguda no setor de emergência, seu diagnóstico pode passar despercebido, o que exige um alto índice de suspeição para ser realizado em tempo hábil. A disponibilidade dos métodos de imagem têm contribuído para a prontidão desse diagnóstico. Os objetivos iniciais do tratamento consistem no controle da dor e da pressão arterial através, principalmente, do uso de betabloqueadores endovenosos. Tais medidas diminuem o stress na parede da aorta, minimizando a propagação da delaminação. A identificação da localização do segmento de aorta dissecado é crucial, pois impacta no tratamento e no prognóstico. Pacientes com dissecção tipo B de Stanford e sem complicações podem receber trata-mento medicamentoso exclusivo, enquanto que a dissecção aguda tipo A de Stanford é uma emergência cirúrgica. Em relação à cirurgia, têm-se discutido o benefício da técnica do Frozen Elephant Trunk, a qual corrige uma maior extensão de aorta comprometida, po-dendo beneficiar pacientes com isquemia distal, apesar de apresentar maior complexidade e aumentar o risco de complicações neurológicas. Para as dissecções tipo B, o reparo endovascular tem sido amplamente utilizado e vários especialistas têm sugerido essa abordagem também para os casos não complicados, pois estudos recentes descrevem a influência do tratamento no remodelamento aórtico e, consequentemente, na sobrevida
Aortic dissection is a dramatic condition whose early accurate diagnosis is fundamen-tal for patient survival. Within the context of acute chest pain in the emergency room, its diagnosis can be overlooked, requiring a high level of suspicion to be performed in a timely manner. The availability of imaging methods has contributed to a faster diagnosis. The initial management goal is to control pain and blood pressure, mainly through the use of intra-venous beta-blockers. This strategy decreases shear stress on the aortic wall, minimizing the progression of delamination. Identifying the location of the dissected aortic segment is crucial, as this will impact on the treatment and prognosis. Patients with uncomplicated Stanford type B dissection may receive pharmaceutical treatment alone, while acute type A dissection is a surgical emergency. In relation to surgery, the benefit of the "Frozen Ele-phant Trunk" technique has been discussed, which corrects a greater area of compromised aorta and may benefit patients with distal ischemia, despite adding greater complexity and increasing the risk of neurological complications. For type B dissections, endovascular repair has been widely used, and several experts have also suggested this approach for uncomplicated cases, as recent studies have described the influence of the treatment on aortic remodeling and consequently, on survival
Asunto(s)
Humanos , Masculino , Femenino , Aorta , Disección/métodos , Disección Aórtica/diagnóstico , Disección Aórtica/fisiopatología , Enfermedades de la Aorta , Pronóstico , Dolor en el Pecho/complicaciones , Diagnóstico por Imagen/métodos , Tomografía/métodos , Factores de Riesgo , Ecocardiografía Transesofágica/métodos , Procedimientos Endovasculares/métodos , Hipertensión/terapia , ObesidadRESUMEN
Resumen: El síndrome aórtico agudo incluye un grupo de enfermedades que poseen similitud clínica en su historia natural, siendo la característica más importante su asociación a un alto riesgo vital. Entre estas patologías, el diagnóstico y manejo de la disección aórtica depende del grado de compromiso aórtico según la ubicación de la lesión definida bajo la clasificación de Stanford. Dentro de las manifestaciones clave se considera al dolor torácico como el síntoma cardinal. Sin embargo, existen situaciones que por ambigüedad clínica retrasan el diagnóstico. Se presenta el caso de un paciente que debutó con una disección aórtica Stanford A, con indicación de resolución quirúrgica en fase aguda pero que dado lo inespecífico de su cuadro clínico, no se logró un diagnóstico oportuno. Posterior a reiteradas consultas por cambios en su sintomatología, se determinó el cuadro definitivo a través de estudio imagenológico, evolucionando de forma favorable con terapia ambulatoria.
Abstract: Acute aortic syndrome includes a group of diseases that have clinical similarity in their natural history, the most important characteristic being their association with a high vital risk. The diagnosis and management of aortic dissection depends on the degree of aortic involvement according to the location of the lesion, as defined by the Stanford classification. In this syndrome, chest pain is considered the cardinal symptom; however, there are situations where clinical feedback is difficult. We present the case of a patient who debuted with a Stanford A aortic dissection, with an indication for surgical resolution in the acute phase, but who unexpectedly presented unspecific clinical manifestations. An opportune diagnosis was not obtained. After repeated consultations for changes in his symptoms, the definitive diagnosis was determined through imaging study, evolving favorably with ambulatory therapy.
Asunto(s)
Humanos , Masculino , Persona de Mediana Edad , Dolor en el Pecho/etiología , Disección Aórtica/diagnóstico , Diagnóstico Tardío , Disección Aórtica/fisiopatologíaRESUMEN
Resumen Objetivo: Revisión y análisis de la disección aórtica (DA) en la población mexicana. Método: Revisión retrospectiva de 434 expedientes electrónicos de pacientes con angiotomografía de aorta entre noviembre de 2014 y octubre de 2015. Se obtuvo una muestra de 32 pacientes con diagnóstico de DA de primera vez. Se realizó un análisis de las DA según género, grupo etario, clasificación de Stanford/De Bakey y mortalidad a 6 meses del diagnóstico. Se realizó análisis de significación estadística mediante la Chi-cuadrada para las variables independientes de género, síndrome de Marfan, hipertensión arterial sistémica y enfermedad ateromatosa calcificada en asociación con subtipos, sitios de reentrada y datos de hipoperfusión. Resultados: El 65.6% de los pacientes fueron masculinos, con un promedio de edad de 54.5 años, y el 34.4% fueron femeninos, con un promedio de edad de 42.5 años. El subtipo B/3 fue el más frecuentemente diagnosticado. La tasa de mortalidad a 6 meses fue del 18.7%. Se halló asociación significativa con p marginal en pacientes con síndrome de Marfan y subtipos de DA según Stanford (p = 0.0506), así como asociación significativa en pacientes con aneurisma de aorta abdominal y subtipos de DA según Stanford (p = 0.047104). Conclusiones: La DA es una emergencia en la cual el diagnóstico por imagen y el manejo oportuno son fundamentales para mejorar el pronóstico. En nuestra muestra encontramos asociación significativa de pacientes con antecedente de síndrome de Marfan y aneurisma aórtico abdominal con disecciones según la categoría de Stanford. El resto de las variables independientes no mostraron asociación significativa, en probable relación con el tamaño de la muestra.
Abstract Objective: To review aortic dissection (AD) in the Mexican population. Method: A retrospective study was conducted using 434 medical records of patients with aortic angio-tomography between November 2014 and October 2015. A sample was obtained of 32 patients with a first time diagnosis of AD. An analysis was performed of the dissections according to gender, age group, Stanford/De Bakey classification, and mortality rate 6 months after diagnosis. Statistical analysis was performed by obtaining the Chi squared index for the independent variables of gender, Marfan syndrome, systemic arterial hypertension, as well as calcified atheromatous disease in association with dissection subtypes, re-entry sites, and hypo-perfusion signs. Results: The patients included 65.6% males with a mean age of 54.5 years, and 34.4% females with mean age of 42.5 years. The most common dissection subtype was B/3. Mortality rate at 6 months was 18.7%. There was a significant association, with a marginal P in patients with Marfan syndrome and Stanford subtypes of AD (P = .0506). There was a significant association in patients with abdominal aortic aneurysm, when compared with Stanford subtypes of AD (P = .047104). Conclusions: AD is an emergency in which diagnosis and timely management are essential to improve prognosis. In the sample presented here, a significant association was found in patients with a history of Marfan syndrome and abdominal aneurysms with dissections according to the Stanford classification. The rest of the independent variables did not show any significant association, probably related to the size of the sample.
Asunto(s)
Humanos , Masculino , Femenino , Adolescente , Adulto , Persona de Mediana Edad , Anciano , Anciano de 80 o más Años , Adulto Joven , Aneurisma de la Aorta Abdominal/diagnóstico por imagen , Angiografía por Tomografía Computarizada/métodos , Disección Aórtica/diagnóstico por imagen , Pronóstico , Estudios Retrospectivos , Tamaño de la Muestra , Hipertensión/complicaciones , Disección Aórtica/fisiopatología , Disección Aórtica/mortalidad , Síndrome de Marfan/complicaciones , MéxicoRESUMEN
BACKGROUND: We aim to evaluate clinical features and transcranial Doppler (TCD) elements, as predictors of the development of ischemic events (IEs) in patients suffering from spontaneous carotid arterial dissection without stroke (CCADW). METHODS: Consecutive patients with CCADW, seen in Clínica Alemana de Santiago between April 2004 and January 2015, were evaluated clinically, and with TCD, microembolic signals (MES) monitoring and breath hold Index (BHI) test were performed. RESULTS: Forty-one patients with 45 CCADW were included. Mean age 41.9 years, 31 male, and 12 (29.1%) patients present with multiple CCADW. At the moment of TCD evaluation, 17 (41.4%) patients were being treated with antiplatelets and the rest under Heparin. TCD monitoring lasted in average 53.3 minutes and demonstrated at the moment of evaluation, MES in four carotid arteries (11.1%) of 3 patients and 13 (28.8%) abnormal BHI in 11 patients. Six IEs occurred in 3 patients, 3 strokes, and 3 transient ischemic attacks. In the univariate analysis correlating IE with clinical and ultrasonographic findings, the degree of carotid stenosis, the presence of multiple CAD, and the presence of MES plus abnormalities of BHI were significantly associated with the risk of an IE. Multivariable analysis showed that only the presence of MES plus abnormal BHI were significant (P < .001). MES and abnormal BHI were present in the 3 patients and in four arterial territories that had IE. CONCLUSIONS: TCD can identify a subgroup of patients with CCADW who are at high risk of IE.
Asunto(s)
Disección Aórtica/diagnóstico por imagen , Isquemia Encefálica/diagnóstico por imagen , Enfermedades de las Arterias Carótidas/diagnóstico por imagen , Ultrasonografía Doppler Transcraneal , Adolescente , Adulto , Disección Aórtica/fisiopatología , Vasos Sanguíneos/fisiopatología , Isquemia Encefálica/fisiopatología , Enfermedades de las Arterias Carótidas/fisiopatología , Femenino , Humanos , Embolia Intracraneal/diagnóstico por imagen , Embolia Intracraneal/fisiopatología , Ataque Isquémico Transitorio/diagnóstico por imagen , Ataque Isquémico Transitorio/fisiopatología , Masculino , Persona de Mediana Edad , Factores de Riesgo , Adulto JovenRESUMEN
OBJECTIVE: Whereas uncomplicated acute type B aortic dissections are often medically managed with good outcomes, a subset develop subacute or chronic aneurysmal dilation. We hypothesized that computational fluid dynamics (CFD) simulations may be useful in identifying patients at risk for this complication. METHODS: Patients with acute type B dissection complicated by rapidly expanding aortic aneurysms (N = 7) were compared with patients with stable aortic diameters (N = 7). Three-dimensional patient-specific dissection geometries were generated from computed tomography angiography and used in CFD simulations of pulsatile blood flow. Hemodynamic parameters including false lumen flow and wall shear stress were compared. RESULTS: Patients with rapid aneurysmal degeneration had a growth rate of 5.3 ± 2.7 mm/mo compared with those with stable aortic diameters, who had rates of 0.2 ± 0.02 mm/mo. Groups did not differ in initial aortic diameter (36.1 ± 2.9 vs 34.4 ± 3.6 mm; P = .122) or false lumen size (22.6 ± 2.9 vs 20.2 ± 4.5 mm; P = .224). In patients with rapidly expanding aneurysms, a greater percentage of total flow passed through the false lumen (78.3% ± 9.3% vs 56.3% ± 11.8%; P = .016). The time-averaged wall shear stress on the aortic wall was also significantly higher (12.6 ± 3.7 vs 7.4 ± 2.8 Pa; P = .028). CONCLUSIONS: Hemodynamic parameters derived from CFD simulations of acute type B aortic dissections were significantly different in dissections complicated by aneurysm formation. Thus, CFD may assist in predicting which patients may benefit from early stent grafting.
Asunto(s)
Aneurisma de la Aorta/diagnóstico por imagen , Disección Aórtica/diagnóstico por imagen , Anciano , Disección Aórtica/fisiopatología , Angiografía , Aneurisma de la Aorta/fisiopatología , Simulación por Computador , Femenino , Humanos , Hidrodinámica , Imagenología Tridimensional , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Tomografía Computarizada por Rayos XRESUMEN
Thoracoabdominal aortic aneurysm (TAAA) is a life-threatening condition with a potentially high risk of rupture (46% to 74%) when left untreated. Mean elective surgical mortality rate is 6.6% at best, rising to 47% for emergency operations. Standard thoracic endovascular repair alone is not currently considered an adequate approach to treat TAAA because of the visceral arteries involved by the aneurysm sac. A hybrid procedure and other complex endovascular techniques (eg, chimney graft, fenestrated and side-branched modular endograft systems) have been developed, but results are still conflicting; the procedures are not feasible for all patients and cost is still a concern. The sandwich technique was developed to address these aneurysms and dissection that still cannot be repaired in a safe, efficient, and cost-wise manner. From October 2008 to March 2012, elective and/or emergency sandwich technique repair was undertaken in 15 consecutive patients (80% male, mean age 70.3 years) with TAAA at our institution, with a mean follow-up period of 16.2 (range 1 to 36) months. Technical success rate was 92.3% and, in one patient (TAAA), both renal arteries could not be cannulated by guide wire and the procedure was aborted. Total, elective, and emergency 30-day mortality rates were 20% (3/15), 7.7% (1/13), and 100% (2 of 2), respectively. Two other deaths were unrelated to the procedure and due to hemorrhagic stroke (10 months) and lymphoma (12 months). Forty-eight visceral arteries (mean 3.4 arteries/patient) were successfully endorevascularized (22 renal arteries, 14 superior mesenteric arteries and 12 celiac trunks) with self-expandable covered stents and bare stents inside it in 14 patients. Three right and two left renal arteries could not be cannulated (5 of 54), comprising 9.2% failure to treat target vessels. Primary patency rate was 97.9%, with only 1 of 48 with endorevascularized target vessel occlusion. No spinal cord ischemia events were observed during the follow-up period. Three transient renal function impairments (20%) and one type III endoleak (11%), which sealed spontaneously at the 1-month assessment, were detected. Sandwich technique for TAAA repair is a safe, well-tolerated, feasible alternative using ready-to-use endoprosthesis to provide efficient visceral revascularization in types I, II, III, and IV TAAAs. The sandwich technique appears to be a promising tool in the endovascular repair of TAAA, but more experience with the method is warranted.
Asunto(s)
Aneurisma de la Aorta Torácica/cirugía , Disección Aórtica/cirugía , Implantación de Prótesis Vascular/métodos , Procedimientos Endovasculares/métodos , Anciano , Anciano de 80 o más Años , Disección Aórtica/diagnóstico por imagen , Disección Aórtica/mortalidad , Disección Aórtica/fisiopatología , Aneurisma de la Aorta Torácica/diagnóstico por imagen , Aneurisma de la Aorta Torácica/mortalidad , Aneurisma de la Aorta Torácica/fisiopatología , Aortografía/métodos , Implantación de Prótesis Vascular/efectos adversos , Implantación de Prótesis Vascular/mortalidad , Procedimientos Endovasculares/efectos adversos , Procedimientos Endovasculares/mortalidad , Femenino , Humanos , Estimación de Kaplan-Meier , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/etiología , Estudios Prospectivos , Factores de Tiempo , Tomografía Computarizada por Rayos X , Resultado del Tratamiento , Grado de Desobstrucción VascularAsunto(s)
Humanos , Disección Aórtica/diagnóstico , Disección Aórtica/terapia , Aneurisma de la Aorta/diagnóstico , Aneurisma de la Aorta/terapia , Enfermedad Aguda , Disección Aórtica/clasificación , Disección Aórtica/fisiopatología , Aneurisma de la Aorta/clasificación , Aneurisma de la Aorta/fisiopatología , Dolor en el Pecho/etiología , Servicios Médicos de Urgencia , Pronóstico , Factores de RiesgoAsunto(s)
Aorta Abdominal/crecimiento & desarrollo , Aorta Torácica/crecimiento & desarrollo , Aneurisma de la Aorta Abdominal/cirugía , Aneurisma de la Aorta Torácica/cirugía , Disección Aórtica/cirugía , Procedimientos Quirúrgicos Vasculares/métodos , Disección Aórtica/diagnóstico por imagen , Disección Aórtica/fisiopatología , Aorta Abdominal/diagnóstico por imagen , Aorta Torácica/diagnóstico por imagen , Aneurisma de la Aorta Abdominal/diagnóstico por imagen , Aneurisma de la Aorta Abdominal/fisiopatología , Aneurisma de la Aorta Torácica/diagnóstico por imagen , Aneurisma de la Aorta Torácica/fisiopatología , Humanos , Tomografía Computarizada Espiral , Resultado del TratamientoRESUMEN
Relato de caso de paciente idoso com quadro de hemotoráx à direita levando ao diagnóstico de pseudoaneurisma de aorta torácica. O paciente já havia se submetido a tratamento endovascular prévio e à cirurgia de revascularização do miocárdio. Relata-se um caso cujo tratamento foi realizado por via endovascular e que apresentava dificuldades técnicas quanto à abordagem, via de acesso e eficácia do tratamento
Asunto(s)
Humanos , Masculino , Anciano , Aneurisma de la Aorta/diagnóstico , Aneurisma de la Aorta/fisiopatología , Aneurisma de la Aorta/terapia , Disección Aórtica/diagnóstico , Disección Aórtica/fisiopatología , Disección Aórtica/terapia , Aorta Torácica/anomalías , Aorta Torácica/cirugía , Revascularización Miocárdica/métodos , Revascularización Miocárdica , Procedimientos Quirúrgicos CardíacosRESUMEN
OBJETIVO: Pesquisar a ocorrência de disfunção clínica ou subclínica da tireóide em portadores de dissecção aórtica e analisar se há correlação entre os níveis séricos de hormônios relacionados à função tireoideana e ao conteúdo de material mixóide da média aórtica. MÉTODOS: Níveis séricos de triiodotironina (T3), tiroxina (T4) e hormônio estimulador da tireóide (TSH) foram dosados por métodos convencionais em 28 pacientes em pós-operatório de correção de dissecção aórtica; T4 livre foi medido em 20 deles. Os mesmos hormônios foram quantificados em 20 pacientes-controle pareados por sexo e idade. Os resultados foram comparados pelo teste de Mann-Whitney. A porcentagem da camada média da aorta ocupada por material mixóide foi medida em espécimes cirúrgicos de 25 pacientes e correlacionada aos níveis séricos de hormônios através do teste de Pearson. Estabeleceu-se o nível de significância como p<0,05. RESULTADOS: Nos 20 pares nos quais as quantidades de hormônios foram comparadas, os valores médios de T3, T4, T4 livre e TSH foram 1,22ng/ml, 9,89mcg/dl, 1,18ng/dl e 5,45microUi/ml nos casos e 1,15ng/ml, 8,57mcg/dl, 1,32ng/dl e 2,15microUi/ml nos controles. Nem tais diferenças nem a correlação entre a percentagem de conteúdo mixóide (média= 30 por cento) e os valores de T3, T4, T4 livre e TSH (médias- 1,22ng/ml, 9,44mcg/dl, 1,20ng/dl e 5,08 micro Ui/ml; n=25) foram significantes. CONCLUSAO: Nossos dados sugerem que a dissecção da aorta; não têm relação com os níveis séricos de hormônios tireoideanos.
Asunto(s)
Humanos , Masculino , Femenino , Adulto , Persona de Mediana Edad , Disección Aórtica/fisiopatología , Aorta/patología , Aneurisma de la Aorta/fisiopatología , Glándula Tiroides/fisiopatología , Hormonas Tiroideas/sangre , Disección Aórtica/sangre , Aneurisma de la Aorta/sangreAsunto(s)
Aneurisma de la Aorta/diagnóstico por imagen , Disección Aórtica/diagnóstico por imagen , Válvula Aórtica/diagnóstico por imagen , Ecocardiografía Tridimensional , Disección Aórtica/fisiopatología , Aneurisma de la Aorta/fisiopatología , Válvula Aórtica/fisiopatología , Endotelio Vascular/diagnóstico por imagen , Endotelio Vascular/fisiopatología , Hemodinámica , Humanos , Masculino , Persona de Mediana EdadAsunto(s)
Humanos , Aorta , Aorta/fisiología , Aorta/lesiones , Aorta/anomalías , Aterosclerosis , Enfermedades de la Aorta , Aneurisma de la Aorta , Disección Aórtica/fisiopatología , Disección Aórtica/diagnóstico , Coartación Aórtica , Ecocardiografía Transesofágica , Ecocardiografía Doppler , Aorta/anatomía & histología , Aorta/embriología , ÚlceraAsunto(s)
Humanos , Masculino , Persona de Mediana Edad , Disección Aórtica , Aneurisma de la Aorta , Válvula Aórtica , Ecocardiografía Tridimensional , Disección Aórtica/fisiopatología , Aneurisma de la Aorta/fisiopatología , Válvula Aórtica/fisiopatología , Endotelio Vascular/fisiopatología , Endotelio Vascular , HemodinámicaRESUMEN
Os autores estudaram 30 casos de dissecçäo aórtica entre janeiro de 1978 e dezembro de 1987. Classificou-se a dissecçäo em tipo A (lesäo inicial na aorta ascendente ou crossa) e tipo B (lesäo inicial da aorta descendente). Houve ppredomínio do tipo A (66,7%). A dissecçäo do tipo B foi mais freqüente entre os doentes com mais de 60 anos. A dor precordial foi o sintoma principal entre os do tipo A e em 62,5% dos tipos B este sintoma näo ocorreu. O exame físico de entrada evidenciou, entre os pacientes do tipo A, hipotensäo (45,5%), sopro cardíaco (40,0%) e dispnéia (40,0%); entre os do tipo B, hipertensäo (28,6%) e déficit de pulso (42,9%). O principal diagnóstico diferencial para o tipo A foi infarto do miocárdio (43,8%) e para o tipo B, insuficiência arterial periférica (25,0%) e pneumopatia aguda (25,0%). Hemorragia interna ocorreu em 24 doentes (80,0%). Hemopericárdio ocorreu 68,8% dos doentes do tipo A e 50,0% dos pacientes do tipo B apresentavam hemorragia retroperitoneal. Hipertensäo arterial, aterosclerose, necrose cística da média e alteraçöes endócrinas foram consideradas fatores predisponentes para ambos os tipos de dissecçäo. Observou-se um caso de dissecçäo pós-implante de válvula aórtica associado a prótese de aorta ascencente. O tempo médio de sobrevida, após o aparecimento dos sintomas, foi de 6,3 dias para o tipo A e 11,1 dias para o tipo B. A principal causa de óbito foi a hemorragia interna (70,0%)