Aortic dissections and dissecting aneurysms

doi:10.1016/0002-9149(72)90070-7

The American Journal of Cardiology

Volume 30, Issue 3, August 1972, Pages 263-273

https://doi.org/10.1016/0002-9149(72)90070-7 Get rights and content

Abstract

A review of the history, etiology, pathophysiology, classification, clinical history, physical findings, and laboratory, electrocardiographic and roentogenographic criteria for aortic dissections and dissecting aneurysms is presented. The indications and modes of therapy are discussed as they are being developed and currently practiced.

At present, continuation of drug therapy is favored in patients with uncomplicated type III acute or chronic dissections and in those with severe general contraindications to surgery. However, urgent operative treatment is now reemerging as the procedure of choice for patients with type I acute dissections or complicated type III dissections, as well as for patients who are normotensive. Stricter criteria for continuation of drug therapy and for surgery have been developed on the basis of recent reports and our own experience.

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Thoracic endovascular aortic repair (TEVAR) is gradually becoming a first-line treatment of complicated acute type B aortic dissection (ATBAD). Interestingly, according to years of experience in the treatment of ATBAD, we found that patients with ATBAD often had unexplained noninfectious fever after TEVAR. This study aims to explore its clinical characteristics and independent risk factors.
From January 2016 to September 2021, 211 consecutive patients treated electively by TEVAR for ATBAD were included. The entry tears in all patients originated in the distal to the left subclavian artery (LSA). All patients were diagnosed with ATBAD for the first time. The definition of fever in this study was that the body temperature of patients after TEVAR exceeds 38°C.
A total of 211 patients (53.62 ± 11.34 years, 81% men) were included in the analysis. To compare patients who did and did not have post-TEVAR fever, they were respectively classified as the fever group and the nonfever group. Fever was diagnosed in 115 (55%) patients. Preoperatively, statistical differences were recorded in age (P = 0.023) and red blood cell (P = 0.037). Age <60 years [odds ratio (OR) 2.194, 95% confidence interval (CI) 1.147–4.196, P = 0.018] and duration of the operation >3 hr (OR 3.586, 95% CI 1.133–11.350, P = 0.03) were positively associated with fever. In the comparison of preoperative and postoperative experimental data, the changes in white blood cell (P = 0.046) and platelet (P = 0.007) of the 2 groups were significantly different. Hospital stay (P = 0.009) and postoperative hospital stay (P < 0.001) in the fever group were significantly prolonged. There was no difference in survival in the mid- and long-term follow-up between the 2 groups.
Noninfectious fever occurs in more than half of the patients after TEVAR (115/211, 54.5%). Patients in the fever group are younger. Age <60 years and duration of the operation >3 hr are independent risk factors for noninfectious fever in patients with ATBAD after TEVAR fever. Noninfectious fever after TEVAR may lead to prolonged hospital stay. However, it did not affect mid- and long-term prognosis.
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Emergency surgery for acute type A aortic dissection in patients with previous cardiac surgery is controversial. This study aimed to evaluate the association between previous cardiac surgery and outcomes after surgery for acute type A aortic dissection, to appreciate whether emergency surgery can be offered with acceptable risks.
All patients operated on for acute type A aortic dissection between 2005 and 2014 from the Nordic Consortium for Acute Type A Aortic Dissection database were eligible. Patients with previous cardiac surgery were compared with patients without previous cardiac surgery. Univariable and multivariable statistical analyses were performed to identify predictors of 30-day mortality and early major adverse events (a secondary composite endpoint comprising 30-day mortality, perioperative stroke, postoperative cardiac arrest, or de novo dialysis).
In all, 1159 patients were included, 40 (3.5%) with previous cardiac surgery. Patients with previous cardiac surgery had higher 30-day mortality (30% vs 17.8%, P = .049), worse medium-term survival (51.7% vs 71.2% at 5 years, log rank P = .020), and higher unadjusted prevalence of major adverse events (52.5% vs 35.7%, P = .030). In multivariable analysis, previous cardiac surgery was not associated with 30-day mortality (odds ratio 0.78; 95% CI, 0.30-2.07; P = .624) or major adverse events (odds ratio 1.07; 95% CI, 0.45-2.55, P = .879).
Major adverse events after surgery for acute type A aortic dissection were more frequent in patients with previous cardiac surgery. Previous cardiac surgery itself was not an independent predictor for adverse events, although the small sample size precludes definite conclusions. Previous cardiac surgery should not deter from emergency surgery.
A rare case of thoracic-abdominal aortic aneurysm in conjunction with bilateral superficial femoral artery occlusion, documented with computed tomography angiography
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Aneurysms represent bulging of the weakened blood vessel area, as a result of cystic medial degeneration. Aneurysms chance of rupturing increases over time, resulting in bleeding and death. Therefore, patients with aortic aneurysms require frequent monitoring with magnetic resonance and computed tomography angiography, as well as undergoing open repair surgery and endovascular aneurysm repair.
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Hemoptysis ensued, prompting an MSCT scan, that showed right pleural effusion, atelectasis, and right active perihilar infiltrates with inter-lobar pleurisy. Due to inflammatory changes on the lung parenchyma, the patient got tested for Sars-Cov-2, and resulted positive.
Contrast-enhanced MSCT also revealed thoracic-abdominal aortic aneurysm with its highest diameter measuring 10 cm, and massive per-aortal thrombus and/or hematoma of 5 cm, which was further ruptured and patient died untreated in the fourth day of hospitalization.
Questions arise whether Covid-19 was the primary cause of bilateral superficial femoral artery occlusion and whether high doses of parenteral anticoagulants were the primary cause of thoracic aortic aneurysm rupture.
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Single vs Serial Assessments of Arterial Hemodynamics to Predict Thoracic Aortic Aneurysm Expansion
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Thoracic aortic aneurysm (TAA) is a highly morbid disease. We have previously shown that baseline hemodynamic measures reflecting aortic function are associated with future TAA expansion. However, whether serial arterial hemodynamic assessment further improves TAA growth assessment remains unknown. Therefore, we aimed to compare single vs serial arterial hemodynamic assessments in the evaluation of future TAA growth.
Eighty-six unoperated participants with TAA underwent noninvasive arterial hemodynamic assessment using arterial tonometry and echocardiography at baseline and after 1 year. Aortic diameter was measured serially with the use of standard imaging modalities. Stepwise multivariable linear regression was used to assess associations of baseline and 1-year change (Δ) in arterial hemodynamic measures with TAA growth.
Mean age was 62.7 ± 11.0 years; 79% were male. Mean aneurysm growth was 0.48 ± 0.54 mm/year after a follow-up of 2.96 ± 1.03 years. Yearly changes in arterial hemodynamic measures ranged from −3.2% to +4.2%. Linear regression results showed that while baseline arterial hemodynamic measures were independently associated with aneurysm growth (carotid-femoral pulse wave velocity: β ± SE = 0.038 ± 0.013; aortic characteristic impedance: β ± SE = 0.002 ± 0.001; proximal aortic compliance: β ± SE = −0.011 ± 0.006; forward pressure wave amplitude: β ± SE 0.009 ± 0.002; reflected pressure wave amplitude: β ± SE = 0.017 ± 0.006; P < 0.05 for each), the 1-year Δ in these measures did not incrementally add to aneurysm growth assessment (P > 0.05 for each Δ).
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L'anévrisme de l'aorte thoracique (AAT) est une maladie à morbidité élevée. Nous avons précédemment montré que les mesures hémodynamiques de base qui reflètent la fonction aortique sont associées à l'expansion ultérieure de l'AAT. Toutefois, on ne sait pas encore si une série d'évaluations hémodynamiques artérielles améliore l'évaluation de la progression de l'AAT. Nous avons donc cherché à comparer les évaluations hémodynamiques artérielles, unitaires ou réalisées en série, dans l'évaluation de l'essor de l'AAT.
Quatre-vingt-six participants présentant un AAT, non opérés, ont subi une évaluation hémodynamique artérielle non invasive à l'aide d'une tonométrie artérielle et d'une échocardiographie, au début de l'étude et après un an. Le diamètre aortique a été mesuré périodiquement, en utilisant les modalités d'imagerie standard. Une régression linéaire multiple et séquentielle a été utilisée pour évaluer les associations entre la variation (Δ) des mesures hémodynamiques artérielles au départ et après un an durant la progression de l'AAT.
L'âge moyen était de 62,7 ± 11,0 ans; 79 % étaient des hommes. La croissance moyenne de l'anévrisme était de 0,48 ± 0,54 mm/an après un suivi de 2,96 ± 1,03 ans. Les changements annuels des mesures hémodynamiques artérielles allaient de −3,2 % à +4,2 %. La résultante de la régression linéaire a montré que si les mesures hémodynamiques artérielles de base étaient indépendamment associées au développement de l'anévrisme (vitesse de l'onde de pouls carotido-fémorale: β ± ES = 0,038 ± 0,013; impédance caractéristique de l'aorte: β ± ES = 0,002 ± 0,001; compliance aortique proximale: β ± ES = −0,011 ± 0,006; amplitude de l'onde de pression incidente: β ± ES = 0,009 ± 0,002; amplitude de l'onde de pression réfléchie: β ± ES = 0,017 ± 0,006; P < 0,05 pour chacune), le Δ à un an de ces mesures n'a pas immensément contribué à l'évaluation de la progression de l'anévrisme (P > 0,05 pour chaque Δ).
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^∗: Established Investigator, American Heart Association.

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ReviewAortic dissections and dissecting aneurysms

Abstract

J Thorac Cardiovasc Surg

Amer Heart J

J Thorac Cardiovasc Surg

Amer Heart J

Amer Heart J

J Thorac Cardiovasc Surg

Amer J Obstet Gynec

Amer Heart J

Amer Heart J

Ann Thorac Surg

J Thorac Cardiovas Surg

Ann Thorac Surg

Ann Thorac Surg

Amer J Cardiol

Amer J Cardiol

Amer Heart J

Amer Heart J

Dis Chest

Clin Radiol

Lancet

Vascular Diseases

Bonetus Sepulchr Anatom

Dissecting Aneurysms

Dissecting Aneurysms

Some observations on aneurysms in general

Tr Roy Soc London

Dissecting aneurysm of aorta:its clinical, electrocardiographic and laboratory features: report of fifty-eight autopsied cases

Circulation

Dissecting aneurysm of aorta

Dissecting aneurysm of aorta

Arch Path (Chicago)

Treatise on Aneurysm, 1804

Memoires Physiologiques et Pratiques sur l'Aneurisms et la Ligature ses Arteres

Healed dissecting aneurysm

Dublin Hosp Rec

On recent improvements in the art of distinguishing diseases of the heart. Lumleyan lectures delivered before the Royal College of Physicians, 1829

Acute dissecting aortic aneurysms

Surgery

Case of anomalous aneurysm of the aorta resulting from effusion of blood composing the middle coat of that vessel

Amer J Med Sci

A case of dissecting aneurysm of the aorta

Uber dissezierendarteriitis und Aneurysma dissecans

Beitrage zue Frage des Aneurysma dissecans

Dissecting aneurysm of the aorta; diagnosis and operative relief of acute arterial obstruction due to this cause

New York J Med

Surgical correction of cardiovascular deformities in Marfan's syndrome

Ann Surg

Surgical consideration of dissecting aneurysm of the aorta

Ann Surg

Dissecting aneurysm of the aorta

Brit J Radiol

Selective aortography, the definitive technique for diagnosis of dissecting aneurysm of the aorta

Amer J Roentgen

Dissecting aneurysms of aorta in persons under 40 years of age

Arch Path (Chicago)

Dissecting aneurysms of the aorta

Brit J Radiol

Dissecting aneurysm of aorta; review of 17 autopsied cases of acute dissecting aneurysm of aorta

Ann Intern Med

Symptoms of dissecting aneurysm of aorta

Ann Intern Med

Dissecting aneurysm of aorta in experimental arteriosclerosis

Arch Path (Chicago)

Isolation, structure and synthesis of a lathyrus factor from L. odoratus

J Amer Chem Soc

Scoliosis and dissecting aneurysm of aorta in rats fed with Lathyrus odoratus seeds

Amer J Path

Review
Aortic dissections and dissecting aneurysms