RESUMEN
Presenting this video tutorial, we want to demonstrate a step-by-step surgical approach to acute intramural haematoma of the thoracic aorta without a definite entry tear. Limited by the aortic valve proximally, the intramural haematoma involved the aortic root, ascending aorta, aortic arch, including adjacent parts of supra-aortic branches, and descending aorta extending to the diaphragmatic level. The operative strategy involved urgent total aortic arch replacement with the frozen elephant trunk technique and anatomical reimplantation of the three supra-aortic vessels. The direct open over-the-wire technique was used to cannulate the right axillary artery, and standard venous cannulation was performed while brain protection was achieved with bilateral selective antegrade cerebral perfusion.
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Aorta Torácica , Implantación de Prótesis Vascular , Hematoma , Humanos , Aorta Torácica/cirugía , Hematoma/cirugía , Hematoma/etiología , Hematoma/diagnóstico , Implantación de Prótesis Vascular/métodos , Masculino , Prótesis Vascular , Enfermedades de la Aorta/cirugía , Enfermedades de la Aorta/diagnóstico , Femenino , Persona de Mediana Edad , Anciano , Aneurisma de la Aorta Torácica/cirugía , Aneurisma de la Aorta Torácica/diagnósticoRESUMEN
Aortopathy encompasses a spectrum of conditions predisposing to dilation, aneurysm, dissection, or rupture of the aorta and other blood vessels. Aortopathy is diagnosed commonly in children, from infancy through adolescence, primarily affecting the thoracic aorta, with variable involvement of the peripheral vasculature. Pathogeneses include connective tissue disorders, smooth muscle contraction disorders, and congenital heart disease, including bicuspid aortic valve, among others. The American Heart Association has published guidelines for diagnosis and management of thoracic aortic disease. However, these guidelines are predominantly focused on adults and cannot be applied adeptly to growing children with emerging features, growth and developmental changes, including puberty, and different risk profiles compared with adults. Management to reduce risk of progressive aortic dilation and dissection or rupture in children is complex and involves genetic testing, cardiovascular imaging, medical therapy, lifestyle modifications, and surgical guidance that differ in many ways from adult management. Pediatric practice varies widely, likely because aortopathy is pathogenically heterogeneous, including genetic and nongenetic conditions, and there is limited published evidence to guide care in children. To optimize care and reduce variation in management, experts in pediatric aortopathy convened to generate this scientific statement regarding the cardiovascular care of children with aortopathy. Available evidence and expert consensus were combined to create this scientific statement. The most common causes of pediatric aortopathy are reviewed. This document provides a general framework for cardiovascular management of aortopathy in children, while allowing for modification based on the personal and familial characteristics of each child and family.
Asunto(s)
American Heart Association , Enfermedades de la Aorta , Humanos , Niño , Estados Unidos , Enfermedades de la Aorta/terapia , Enfermedades de la Aorta/diagnóstico , Adolescente , Manejo de la Enfermedad , Lactante , PreescolarRESUMEN
Clinical cases referring to the EACTS/STS Guidelines for diagnosing and treating acute and chronic syndromes of the aortic organ aim to assist physicians in selecting the best management strategies for individual patients with a given condition. These expert opinions consider the impact on patient outcomes as well as the risk-benefit ratio of different diagnostic or therapeutic methods. These cases serve as a vital tool to aid physicians in making decisions in their daily practice. However, in essence, although these recommendations serve as a valuable resource to guide clinical practice, their application should be tailored to the needs of the individual patient. Each patient's case is unique, presenting its own set of variables and circumstances. This editorial is a tool designed to support, but not supersede, the decision-making process of physicians, based on their knowledge, expertise and understanding of their patients' individual situations. Furthermore, these clinical cases are based on the EACTS/STS Guidelines for diagnosing and treating acute and chronic syndromes of the aortic organ but should not be interpreted as legally binding documents. The legal responsibilities of healthcare professionals remain firmly grounded in applicable laws and regulations, and the guidelines and the clinical cases presented in this document do not alter these obligations.
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Guías de Práctica Clínica como Asunto , Humanos , Enfermedad Aguda , Enfermedad Crónica , Enfermedades de la Aorta/diagnóstico , Enfermedades de la Aorta/terapia , Masculino , Femenino , SíndromeRESUMEN
PRACTICAL RELEVANCE: Feline aortic thromboembolism (FATE) is commonly encountered in clinical medicine, especially in emergency situations. This often devastating syndrome usually develops secondarily to severe heart disease, and has short- and long-term consequences. CLINICAL FEATURES: The clinical presentation of FATE is consistent with peripheral ischemic neuropathy, usually in both pelvic limbs. Diagnosis is relatively straightforward, but can be assisted with Doppler ultrasound, point-of-care ultrasound or infrared thermal imaging. RECENT ADVANCES AND FUTURE PROSPECTS: Interpretation of survival rates in cats with FATE has been hampered by historically high admission euthanasia, but recent studies suggest a survival rate with supportive care of 30-40%. Moreover, with advances in post-FATE thromboprophylaxis, median survival times of over 1 year are being achieved. Future directions include use of thrombolytic agents and treatment of common FATE sequelae such as acute kidney injury and reperfusion injury. OUTLINE: This article, aimed at small animal veterinarians, including emergency practitioners, reviews key aspects of the clinical presentation, diagnosis and treatment options for FATE, with a view to guiding client and veterinarian decision-making. Three case studies are included to illustrate the practical application of information presented in the review. EVIDENCE BASE: There are limited prospective studies on FATE, although the recent literature reflects a resurgence in clinical research interest in the past few years. Advances in FATE treatment will benefit many cats and it is important that research efforts continue to identify appropriate treatment modalities.
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Enfermedades de la Aorta , Enfermedades de los Gatos , Tromboembolia , Gatos , Enfermedades de los Gatos/diagnóstico , Enfermedades de los Gatos/terapia , Animales , Enfermedades de la Aorta/veterinaria , Enfermedades de la Aorta/diagnóstico , Tromboembolia/veterinaria , Tromboembolia/prevención & control , Femenino , MasculinoRESUMEN
Aortic diseases require a multidisciplinary management for diagnosis, treatment and follow-up with better outcomes in referral centers using a team-based approach. The setting up of a multi-disciplinary aortic team for the discussion of complex cases has been already proposed; it is also supported by the ACC/AHA. Surgeons and radiologists, more or less other physicians such as cardiologists, geneticists, rheumatologists/internal medicine specialists and pathologists are involved into such a team. The role of the cardiovascular pathologist is to examine the aortic specimens, to diagnose and classify the aortic lesions. Herein, the role of the pathologist in the aortic team is discussed and the pathobiology of aortic diseases is reviewed for reference by pathologists. The aortic specimens are mainly obtained from emergency or elective surgical procedures on the thoracic aorta, less frequently from organ/tissue (including cardiac or heart valve) donors, post-mortem procedures or abdominal aortic surgery. In the last decade, together with the progress of medical sciences, the histological definitions and classifications of the aortic pathology are undergoing thorough revisions that are addressed to an etiopathogenetic approach because of possible clinico-pathological correlations, therapeutic and prognostic impact. Pathologists may also have an important role in research and teaching. Therefore, histological analyses of the aortic specimens require adequate sample processing and pathologist expertise because histology contributes to definite diagnosis, correct management of patients and even (in genetic diseases) families, but also to research in the challenging field of aortopathies.
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Enfermedades de la Aorta , Patólogos , Grupo de Atención al Paciente , Humanos , Enfermedades de la Aorta/patología , Enfermedades de la Aorta/terapia , Enfermedades de la Aorta/clasificación , Enfermedades de la Aorta/diagnóstico , Aorta/patología , Aorta/cirugía , Valor Predictivo de las Pruebas , Comunicación Interdisciplinaria , Pronóstico , BiopsiaRESUMEN
This study compared the prognostic value of quantified thoracic artery calcium (TAC) including aortic arch on chest CT and coronary artery calcium (CAC) score on ECG-gated cardiac CT. METHODS: A total of 2412 participants who underwent both chest CT and ECG-gated cardiac CT at the same period were included in the Multi-Ethnic Study of Atherosclerosis Exam 5. All participants were monitored for incident atherosclerotic cardiovascular disease (ASCVD) events. TAC is defined as calcification in the ascending aorta, aortic arch and descending aorta on chest CT. The quantification of TAC was measured using the Agatston method. Time-dependent receiver-operating characteristic (ROC) curves were used to compare the prognostic value of TAC and CAC scores. RESULTS: Participants were 69±9 years of age and 47% were male. The Spearman correlation between TAC and CAC scores was 0.46 (p<0.001). During the median follow-up period of 8.8 years, 234 participants (9.7%) experienced ASCVD events. In multivariable Cox regression analysis, TAC score was independently associated with increased risk of ASCVD events (HR 1.31, 95% CI 1.09 to 1.58) as well as CAC score (HR 1.82, 95% CI 1.53 to 2.17). However, the area under the time-dependent ROC curve for CAC score was greater than that for TAC score in all participants (0.698 and 0.641, p=0.031). This was particularly pronounced in participants with borderline/intermediate and high 10-year ASCVD risk scores. CONCLUSION: Our study demonstrated a significant association between TAC and CAC scores but a superior prognostic value of CAC score for ASCVD events. These findings suggest TAC on chest CT provides supplementary data to estimate ASCVD risk but does not replace CAC on ECG-gated cardiac CT.
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Enfermedad de la Arteria Coronaria , Calcificación Vascular , Humanos , Masculino , Femenino , Anciano , Calcificación Vascular/diagnóstico por imagen , Calcificación Vascular/epidemiología , Enfermedad de la Arteria Coronaria/diagnóstico por imagen , Enfermedad de la Arteria Coronaria/epidemiología , Enfermedad de la Arteria Coronaria/diagnóstico , Pronóstico , Persona de Mediana Edad , Medición de Riesgo/métodos , Angiografía por Tomografía Computarizada , Valor Predictivo de las Pruebas , Aorta Torácica/diagnóstico por imagen , Factores de Riesgo , Enfermedades de la Aorta/diagnóstico por imagen , Enfermedades de la Aorta/epidemiología , Enfermedades de la Aorta/diagnóstico , Curva ROC , Vasos Coronarios/diagnóstico por imagen , Técnicas de Imagen Sincronizada Cardíacas , Estados Unidos/epidemiología , Electrocardiografía , Incidencia , Angiografía Coronaria/métodos , Tomografía Computarizada por Rayos X , Aterosclerosis/epidemiología , Aterosclerosis/diagnósticoAsunto(s)
Suministros de Energía Eléctrica , Fístula Esofágica , Cuerpos Extraños , Humanos , Fístula Esofágica/etiología , Fístula Esofágica/diagnóstico , Cuerpos Extraños/complicaciones , Masculino , Suministros de Energía Eléctrica/efectos adversos , Enfermedades de la Aorta/etiología , Enfermedades de la Aorta/diagnóstico , Lactante , Fístula Vascular/etiología , Fístula Vascular/diagnósticoAsunto(s)
Enfermedades de la Aorta , Fístula Intestinal , Fístula Vascular , Humanos , Fístula Intestinal/diagnóstico , Fístula Intestinal/diagnóstico por imagen , Fístula Vascular/diagnóstico , Fístula Vascular/diagnóstico por imagen , Fístula Vascular/cirugía , Enfermedades de la Aorta/cirugía , Enfermedades de la Aorta/diagnóstico por imagen , Enfermedades de la Aorta/diagnóstico , Masculino , AncianoRESUMEN
With the further development and long-term follow-up of endovascular treatment for aortic diseases, increasing evidence shows that in many cases, there are difficulties in the diagnosis of causes, decision-making of treatment timing, and lack of effective evaluation of treatment prognosis in endovascular treatments. Therefore, it is necessary to conduct in-depth research on non-invasive treatment including prevention, diagnosis, treatment, and prediction of aortic diseases. The non-invasive treatment of aortic disease is mainly applied to high-risk populations with aortic dissection, regulating key targets and mechanisms, and adopting drug intervention in advance to achieve the goal of controlling aortic dilation and preventing the occurrence of dissection. It also conducts precise multi omics analysis to determine the optimal intervention timing and treatment strategy, and aims at complications related to aortic disease or endovascular treatment for patients with a positive family history of aortic dilation and those who have developed aortic dissection. Precise regulation can control the progression of aortic aneurysm and aortic dissection, delay or achieve long-term stable coexistence with aortic disease, and even reverse disease progression and achieve benign aortic remodeling through new intervention vectors. Ultimately achieving the ideal state of complete thrombosis and mechanized healing of the aortic aneurysm or aortic dissection false lumen.
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Enfermedades de la Aorta , Disección Aórtica , Humanos , Disección Aórtica/terapia , Disección Aórtica/diagnóstico , Enfermedades de la Aorta/terapia , Enfermedades de la Aorta/diagnóstico , Procedimientos Endovasculares/métodos , Aneurisma de la Aorta/terapia , Aneurisma de la Aorta/diagnósticoRESUMEN
PURPOSE OF REVIEW: The incorporation of genetic counseling and testing is essential to evaluation and management of thoracic aortic disease in patients under 60âyears of age and those with family histories suspicious for heritable thoracic aortic disease and disorders associated with increased risk for acute type-A aortic dissection. RECENT FINDINGS: As many as 20% of individuals with thoracic aortic disease under the age of 60âyears have autosomal dominant patterns of inheritance. A considerable number of heritability factors remain undefined for these families. SUMMARY: Genetic aortopathy programs require a collaborative approach including cardiovascular specialists and surgeons, medical geneticists, genetic counselors, and allied healthcare professionals. Comprehensive evaluation and management of these patients includes collection of detailed phenotypic data to inform the broader community and identify new associated and causative genes of interest, genetic modifiers, and other risk factors. These programs optimize outcomes and reduce the overall burden in the population of acute aortic dissection and related comorbidities.
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Enfermedades de la Aorta , Humanos , Enfermedades de la Aorta/genética , Enfermedades de la Aorta/terapia , Enfermedades de la Aorta/diagnóstico , Asesoramiento Genético/métodos , Pruebas Genéticas/métodos , Desarrollo de Programa , Disección Aórtica/genética , Disección Aórtica/diagnóstico , Disección Aórtica/terapia , Aneurisma de la Aorta Torácica/genética , Aneurisma de la Aorta Torácica/diagnóstico , Aneurisma de la Aorta Torácica/terapia , Grupo de Atención al Paciente , Predisposición Genética a la Enfermedad , Persona de Mediana EdadRESUMEN
The acute aortic syndromes (AAS) are life-threatening vascular compromises within the aortic wall. These include aortic dissection (AD), intramural hematoma (IMH), penetrating aortic ulcer (PAU), and blunt traumatic thoracic aortic injury (BTTAI). While patients classically present with chest pain, the presentation may be highly variable. Timely diagnosis is critical to initiate definitive treatment and maximize chances of survival. In high-risk patients, treatment should begin immediately, even while diagnostic evaluation proceeds. The mainstay of medical therapy is acute reduction of heart rate and blood pressure. Surgical intervention is often required but is informed by patient anatomy and extent of vascular compromise.
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Enfermedades de la Aorta , Disección Aórtica , Humanos , Enfermedades de la Aorta/diagnóstico , Triaje , AortaRESUMEN
INTRODUCTION: Acute aortic occlusion (AAO) is a rare but serious condition associated with significant morbidity and mortality. OBJECTIVE: This review provides an emergency medicine focused evaluation of AAO, including presentation, assessment, and emergency department (ED) management based on current evidence. DISCUSSION: AAO refers to obstruction of blood flow through the aorta due to either thrombosis or embolism. This condition primarily affects older adults ages 60-70 with cardiovascular comorbidities and most commonly presents with signs and symptoms of acute limb ischemia, though the gastrointestinal tract, kidneys, and spinal cord may be affected. The first line imaging modality includes computed tomography angiography of the chest, abdomen, and pelvis. ED resuscitative management consists of avoiding extremes of blood pressure or heart rate, maintaining normal oxygen saturation and euvolemic status, anticoagulation with heparin, and pain control. Emergent consultation with the vascular surgery specialist is recommended to establish a plan for restoration of perfusion to ischemic tissues via endovascular or open techniques. High rates of baseline comorbidities present in the affected population as well as ischemic and reperfusion injuries place AAO patients at high risk for complications in an immediate and delayed fashion after surgical management. CONCLUSIONS: An understanding of AAO can assist emergency clinicians in diagnosing and managing this rare but devastating disease.
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Enfermedades de la Aorta , Arteriopatías Oclusivas , Embolia , Trombosis , Humanos , Anciano , Procedimientos Quirúrgicos Vasculares/efectos adversos , Trombosis/etiología , Embolia/complicaciones , Arteriopatías Oclusivas/diagnóstico , Arteriopatías Oclusivas/terapia , Arteriopatías Oclusivas/etiología , Enfermedades de la Aorta/diagnóstico , Enfermedades de la Aorta/terapia , Aorta Abdominal/cirugía , Isquemia/diagnóstico , Isquemia/etiología , Isquemia/terapiaRESUMEN
Recent medical research has explored Red Cell Distribution Width (RDW) as a potential biomarker for predicting adverse clinical outcomes in patients with aortic pathologies. The study "Systematic literature review and critical analysis of RDW in patients with aortic pathologies" conducted a pooled analysis of 704 patients, revealing a consistent association between elevated RDW levels and adverse clinical progression. While the study provides valuable insights into RDW's diagnostic and prognostic potential, limitations include the inclusion of a limited number of articles and the lack of direct comparison with established biomarkers or imaging techniques. Further research is needed to validate RDW's clinical utility and elucidate underlying biological mechanisms. RDW shows promise as a cost-effective marker for risk stratification and monitoring in clinical practice, but further validation and refinement are necessary for its full clinical impact in aortic diseases.
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Enfermedades de la Aorta , Biomarcadores , Índices de Eritrocitos , Humanos , Enfermedades de la Aorta/sangre , Enfermedades de la Aorta/diagnóstico , Biomarcadores/sangre , Índices de Eritrocitos/fisiología , Pronóstico , Medición de Riesgo/métodos , Revisiones Sistemáticas como AsuntoRESUMEN
Diseases of the aorta, such as aortic aneurysm, dissection, and rupture, account for a large proportion of acute clinical emergencies. The red blood cell distribution width (RDW), which directly reflects anisocytosis (i.e., the heterogeneity of erythrocyte volumes), has emerged as a promising biomarker for many cardiovascular pathologies. Thus, we aimed to explore the implication of RDW in aortic pathologies. We searched Scopus and PubMed using the keywords "RDW" OR "red blood cell distribution width" AND "aortic aneurysm" OR "aortic dilatation" OR "aortic dissection" for identifying studies in which RDW values were measured in patients with these aortic diseases. Ten observational studies were finally included. In all studies, RDW value was increased in patients with aortic diseases. In the four studies in which sufficient RDW data were available for pooling, the weighted mean difference (WMD) of RDW in patients with or without complicated aortic pathologies was 0.575 (95 %CI, 0.254-0.896). RDW may be a valuable diagnostic and prognostic biomarker in patients with aortic pathologies.
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Biomarcadores , Índices de Eritrocitos , Humanos , Índices de Eritrocitos/fisiología , Biomarcadores/sangre , Disección Aórtica/sangre , Disección Aórtica/diagnóstico , Pronóstico , Enfermedades de la Aorta/sangre , Enfermedades de la Aorta/diagnóstico , Aneurisma de la Aorta/sangre , Aneurisma de la Aorta/diagnósticoRESUMEN
BACKGROUND: Supra aortic obstruction in children is uncommon and is seen in certain unique conditions. While intraluminal obstruction due to heavy calcification is seen in older populations, it is not described in pediatric populations. The coral reef aorta is a rare and distinct calcifying disease causing luminal obstruction of the suprarenal aorta in adults. The definition of this diagnosis relies entirely on the unique aspects and consistency of the lesions, which are rock-hard, irregular, gritty plaques with a white luminal surface resembling a coral reef. However, no such case has been described in children. CASE PRESENTATION: We present an adolescent boy who presented with a heavily calcified ascending aortic lesion associated with aortopathy and hypertension, 12 years after an aortic coarctation repair. The investigations included echocardiography, magnetic resonance and computer-tomographic imaging. A 3-D model was printed in order to visualize and plan surgical steps in advance for safe placement of clamps and defining the extent of resection. In addition, it provided an idea about tissue quality, thickness, spatial relationship, and orientation in relation to surrounding structures. Successful resection and replacement of the diseased segment of the aorta were achieved on cardiopulmonary bypass support. Post-operative recovery was uneventful, and at 6-month follow-up, the patient is doing well. In this report, various aspects of such lesions have been discussed, including clinical presentations, complications, planning and conduct of a safe cardiopulmonary bypass, and precautions during surgery for a successful outcome. CONCLUSION: Complicated obstructive aortic lesions in children require careful assessment, appropriate advanced imaging, and the use of 3-D printing technology in order to plan and perform safe and effective surgical management. The etiology of severe calcified aorta in children may be related to metabolic factors, previous surgery, use of a homograft, or an inflammatory process. However, it has yet to be proven.
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Coartación Aórtica , Enfermedades de la Aorta , Adolescente , Humanos , Masculino , Aorta Abdominal/cirugía , Aorta Torácica/diagnóstico por imagen , Aorta Torácica/cirugía , Aorta Torácica/patología , Coartación Aórtica/complicaciones , Coartación Aórtica/diagnóstico , Coartación Aórtica/cirugía , Enfermedades de la Aorta/complicaciones , Enfermedades de la Aorta/diagnóstico , Enfermedades de la Aorta/cirugía , Arrecifes de CoralRESUMEN
Primary aortoduodenal fistula is a rare condition caused mainly by a bulging infra-renal aortic aneurysm with subsequent erosion of the duodenum and formation of a fistula. We present a patient who suffered from a herald upper gastrointestinal bleeding followed by circulo-respiratory collapse only hours after, due to bleeding from the fistula. The mortality is reported to be 100 %, requiring emergency EVAR or open aortic graft repair to control any further bleeding.
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Aneurisma de la Aorta Abdominal , Enfermedades de la Aorta , Enfermedades Duodenales , Fístula Intestinal , Humanos , Fístula Intestinal/diagnóstico , Fístula Intestinal/diagnóstico por imagen , Enfermedades de la Aorta/diagnóstico , Enfermedades de la Aorta/diagnóstico por imagen , Enfermedades Duodenales/complicaciones , Enfermedades Duodenales/diagnóstico , Enfermedades Duodenales/cirugía , Hemorragia Gastrointestinal/etiología , Hemorragia Gastrointestinal/cirugía , Aneurisma de la Aorta Abdominal/diagnóstico , Aneurisma de la Aorta Abdominal/diagnóstico por imagenRESUMEN
Acute aortic syndrome embraces a group of heterogenous pathological entities involving the aortic wall with a common clinical profile. The current epidemiology, clinical presentation, diagnosis and treatment strategy are discussed in this review. Besides, the importance of multidisciplinary aortic teams, aortic centers and the implementation of an aortic code are emphasized.